曾一教授治疗哺乳期肉芽肿性乳腺炎验案1则

Professor ZENG Yi’s experience in treating one case of lactation granulomatous mastitis

肉芽肿性小叶性乳腺炎即特发性肉芽肿性乳腺炎,中医学将其划分到“乳痈”“乳漏”范畴中,它是一种以乳房突发肿块为主要表现,伴疼痛,更有甚者伴有皮肤的破溃、病灶内形成窦道及瘘管等,同时可伴见四肢的结节性红斑、体温升高、咳嗽等全身症状的乳房良性疾病。该病属于非细菌感染性疾病,主要病理表现为乳腺小叶的非干酪样坏死并伴有肉芽肿形成,多见于非哺乳期的育龄期女性,多于末次生产后的1.5~5年发病,妊娠期及哺乳期较为少见。其发病原因及机制尚未明确,治疗亦无统一标准,目前临床常使用的治疗手段包括手术治疗、激素及免疫抑制药物治疗、中医药治疗等。近年来,随着多孩政策的开放,该病的发病率逐年增加,妊娠期发病患者也越来越多见,但对于哺乳期发病的相关报道还是较少。曾一教授临床诊治肉芽肿性小叶性乳腺炎时先掌握患者病史,然后明确病因,注重内外同治,充分发挥中医治疗特色。文章通过对曾一教授门诊1例哺乳期发病的肉芽肿性小叶性乳腺炎患者发病、诊断、治疗过程的介绍,提出肉芽肿性小叶性乳腺炎的鉴别要点,总结曾一教授对于肉芽肿性小叶性乳腺炎的诊疗经验,为肉芽肿性小叶性乳腺炎的临床诊疗提供参考。

Granulomatous lobular mastitis,that is,idiopathic granulomatous mastitis,is divided into breast carbuncle and breast leakage in traditional Chinese medicine,which is a kind of breast benign disease with sudden breast mass as the main manifestation,accompanied by pain,even accompanied by skin rupture,sinus and fistula in the focus,nodular erythema on extremities,elevated body temperature,cough and other systemic symptoms.The disease is a non-bacterial infectious disease,which is characterized by non-caseous necrosis of breast lobules and granuloma formation.The disease is more common in non-lactation women of childbearing age,usually develops within 1.5 to 5 years after the last delivery,and is rare in pregnancy and lactation.The cause and mechanism of the disease are not clear,and there is no unified standard for treatment.At present,the commonly used treatment methods include surgical treatment,hormone and immunosuppressive drug therapy,traditional Chinese medicine and so on.In recent years,with the opening of the policy of multiple births,the incidence of the disease has increased year by year,and the incidence of pregnancy has become more and more common,but there are still few reports on the incidence of lactation.Professor ZENG Yi gives full play to the characteristics of traditional Chinese medicine in the clinical diagnosis and treatment of this disease,first grasps the patient’s medical history,then defines the cause,and pays attention to internal and external treatment.Based on the introduction of the pathogenesis,diagnosis and treatment of one case of granulomatous lobular mastitis in Professor ZENG Yi’s clinic,this paper puts forward the main points of differential diagnosis of granulomatous lobular mastitis.Professor ZENG Yi’s experience in the diagnosis and treatment of granulomatous lobular mastitis is summarized in order to provide reference for the clinical diagnosis and treatment of granulomatous lobular mastitis.