协和医学杂志

2019, v.10(06) 692-697

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173例病理性乳头溢液临床病理特点及诊治分析
Retrospective Analysis of 173 Patients with Pathological Nipple Discharge

徐颖;孙强;周星彤;沈松杰;赵佳琳;陈畅;
XU Ying;SUN Qiang;ZHOU Xing-tong;SHEN Song-jie;ZHAO Jia-lin;CHEN Chang;Department of Breast Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

摘要(Abstract):

目的分析病理性乳头溢液患者的临床、病理特点及其随诊情况,以期为临床诊治提供依据。方法回顾性收集北京协和医院2015年1月至12月间住院治疗的病理性乳头溢液患者的临床、病理及术后随访资料,根据乳头溢液的性质将患者分为血性溢液组和非血性溢液组,比较两组患者的临床、病理特点。结果 173例符合纳入和排除标准的女性患者入选本研究,平均年龄(45. 65±13. 48)岁,中位病程3 (1,12)个月,其中血性溢液119例(68. 8%,119/173),非血性浆液性溢液54例(31. 2%,54/173);术前111例(64. 2%,111/173)经超声检查发现存在病变。血性溢液组和非血性溢液组在年龄、病程、术前体格和钼靶检查结果、术后病理分型等方面差异无统计学意义(P均>0. 05);在术前超声检查(是否发现病变)及术后病理诊断(是否为乳腺癌)方面差异存在统计学意义(P=0. 012和P=0. 045)。血性溢液患者中恶性病变组的年龄更大(P=0. 014)。术后中位随访17 (14,20)个月,病理诊断为乳腺癌的患者均无复发、转移及死亡。结论血性溢液提示高乳腺恶性病变风险,其中年龄较大者乳腺癌风险更高。大部分乳头溢液患者,特别是血性溢液患者术前超声检查可发现病变。手术治疗是明确诊断并进行治疗的有效手段,术后预后较好。
Objective The clinical and pathological features and the follow-ups of 173 patients with pathological nipple discharge were analyzed to provide the basis for diagnosis and treatment. Methods We reviewed the data of the patients who suffered from pathological nipple discharge and as well underwent surgery in Peking Union Medical College Hospital from Jan to Dec 2015. According to the characteristics of nipple discharge,the patients were divided into groups of hemorrhagic and non-hemorrhagic nipple discharge. We compared the clinical and pathological characteristics between the two groups. Results A total of 173 patients who met the inclusion and exclusion criteria were enrolled in this study,all of whom were female,with an average age of( 45. 65 ± 13. 48) years and a median course of disease of 3( 1,12) months. Among them,119 patients( 68. 8%,119/173) had hemorrhagic discharge; 54 patients( 31. 2%,54/173) had non-hemorrhagic serous discharge. 111 patients( 64. 2%,111/173) had lesions detected by ultrasound before surgery. There was no significant difference in age,course of the disease,preoperative physical condition,molybdenum target examination results,and the postoperative pathological classification between the two groups( all P > 0. 05).There were statistically significant differences in preoperative ultrasound examination( whether lesions were found) and postoperative pathological diagnosis( whether breast cancer was found)( P = 0. 012 and P =0. 045). The age of the malignant lesion group was older in patients with hemorrhagic discharge( P = 0. 014).After a median follow-up of 17( 14,20) months,none of the patients who were diagnosed with breast cancer had a recurrence,metastasis,or deceased. Conclusions Hemorrhagic nipple discharge showed a higher risk of breast cancer,especially for elder patients. Ultrasound revealed more lumps than physical examination and mammography. Since the examinations can not identify the malignant lesions out of the symptoms of nipple discharge,surgery is always needed and the postoperative prognosis is quite good.

关键词(KeyWords): 病理性乳头溢液;血性溢液;乳腺癌
pathological nipple discharge;hemorrhagic nipple discharge;breast cancer

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作者(Author): 徐颖;孙强;周星彤;沈松杰;赵佳琳;陈畅;
XU Ying;SUN Qiang;ZHOU Xing-tong;SHEN Song-jie;ZHAO Jia-lin;CHEN Chang;Department of Breast Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

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