摘要
目的总结乳头溢液患者乳管镜下不同数量隆起性病变的临床特征,指导临床对乳头溢液患者的诊断。方法选取2007年7月—2014年12月就诊于中国医科大学第四附属医院的乳头溢液患者515例,患者均行乳管镜检查,且镜下显示存在隆起性病变。回顾性分析乳管镜下不同数量隆起性病变患者的临床特征,包括年龄、乳头溢液情况、溢液孔数、溢液颜色,并观察其乳管镜下隆起性病变所在乳管级别。结果 515例乳头溢液患者中单发隆起性病变454例(88.2%),多发隆起性病变61例(11.8%);年龄≥45岁274例(53.2%),<45岁241例(46.8%);单侧乳头溢液460例(89.3%),双侧乳头溢液55例(10.7%);单孔溢液420例(81.6%),多孔溢液95例(18.4%);红色血性溢液233例(45.3%),黄色浆液性溢液221例(42.9%),无色清水样溢液47例(9.1%),白色乳汁样溢液14例(2.7%);乳管镜下隆起性病变为3级乳管及以下437例(84.9%),隆起性病变为3级乳管以上78例(15.1%)。多发隆起性病变患者双侧乳头溢液所占比例、多孔溢液所占比例大于单发隆起性病变(P<0.05);单发、多发隆起性病变患者年龄、溢液颜色比较,差异无统计学意义(P>0.05)。单发隆起性病变患者乳管镜下隆起性病变为3级乳管以上者52例(11.5%),多发隆起性病变乳管镜下隆起性病变为3级乳管以上者26例(42.6%);多发隆起性病变患者乳管镜下隆起性病变为3级乳管以上的发生率大于单发隆起性病变,差异有统计学意义(χ2=40.651,P<0.01)。结论临床应关注乳头溢液患者的临床特征,当患者出现双侧乳头溢液、多孔溢液,且乳管镜下隆起性病变为3级以上乳管时,应警惕患者乳管内多发隆起性病变的可能;而患者年龄、乳头溢液颜色不能帮助分辨患者是否出现不同数量乳管内隆起性病变。
Objective To provide guidance for clinical diagnosis of patients with nipple discharge by studying the clinical features of protrusion lesions of nipple discharge patients with different amounts of protrusion lesions under breast ductoscopy. Methods In 515 patients with nipple discharge under treatment in the Fourth Affiliated Hospital of China Medical University from July 2007 to December 2014 were selected; all patients received breast ductoscopy and protrusion lesions were observed by breast ductoscopy. Clinical features of patients with different amounts of protrusion lesions under breast ductoscopy were retrospectively analyzed,including age,discharge amount,pore number,discharge color,and grade of duct of protrusion lesions were observed by breast ductoscopy. Results In 515 patients with nipple discharge,454 cases（ 88. 2%） were diagnosed with single protrusion lesion and 61 cases（ 11. 8%） were diagnosed with multiple protrusion lesions; 274 cases（ 53. 2%） were≥45 years old and 241 cases（ 46. 8%） were〈 45 years old; 460 cases（ 89. 3%） had unilateral nipple discharge and 55 cases（ 10. 7%） had bilateral nipple discharge; 420 cases（ 81. 6%） had single- pore nipple discharge and 95 cases（ 18. 4%） had multiple- pore nipple discharge; 233 cases（ 45. 3%） had red bloody discharge,221 cases（ 42. 9%） had discharge of yellow serosity,47 cases（ 9. 1%） had colorless water- like discharge and 14 cases（ 2. 7%） had white milk- like discharge; 437cases（ 84. 9%） had protrusion lesions on ducts below and equal to Grade 3 and 78 cases（ 15. 1%） had protrusion lesions on ducts above Grade 3. Proportion of bilateral nipple discharge and multiple- pore nipple discharge in patients with multiple protrusion lesions were both larger than those in patients with single protrusion lesions（ P〈0. 05）; there was no significant difference in age and discharge color between patients with single and mulliple of protrusion lesions（ P〉0. 05）. 52 cases（ 11. 5%） of single protrusion lesions had protrusion lesions on ducts above Grade 3 under breast ductoscopy and 26 cases（ 42. 6%） of multiple protrusion lesions had protrusion lesions on ducts above Grade 3 under breast ductoscopy; the incidence rate of protrusion lesions on ducts above Grade 3 under breast ductoscopy in patients with multiple protrusion lesions was higher than that in patients with single protrusion lesions（ χ^2= 40. 651,P〈0. 01）. Conclusion Attention should be paid to clinical features of nipple discharge. When a patient is diagnosed with bilateral nipple discharge,multiple- pore nipple discharge and protrusion lesions on ducts above Grade 3 under breast ductoscopy,the patient should be informed of the possibility of multiple protrusion lesions; however age and discharge color cannot help to judge whether protrusion lesions of different amounts exist.
作者
曲文志
李子豪
涂巍
QU Wen - zhi LI Zi - hao TU Wei.(Department of the Fifth General Surgery （ Breast Surgery）, the Fourth Affiliated Hospital of China Medical University, Shenyang 110032, China)
出处
《中国全科医学》
CAS
CSCD
北大核心
2016年第30期3711-3713,3718,共4页
Chinese General Practice
关键词
乳溢
乳腺疾病
纤维乳管镜
多发隆起性病变
Galactorrhea
Breast diseases
Fiberoptic ductoscopy
Multiple apophysis lesions
