目的

探讨男性乳房发育症的病因、发病机制及最佳诊断和治疗方法。

方法

将本院自1999年1月至2008年12月门诊诊治和收住院的268例男性乳房发育症患者的临床资料结合文献复习进行综合分析。计数资料的比较采用χ² 检验。

结果

生理性男性乳房发育240例,病理性男性乳房发育28例。后者根据其病因又分为: 药物性男性乳房发育12例;肿瘤性男性乳房发育11例,其中肺癌4例,胃癌2例,肾上腺肿瘤2例,睾丸肿瘤2例,肾癌1例;其他5例,其中Klinefelter's综合征2例,甲状腺机能亢进和甲状腺机能低下各1例,尿毒症1例。随访结果: 单纯临床观察组乳房发育完全消退率72.73%(56/77);药物治疗组的完全消退率达77.34%(99/128),疼痛缓解率达85.16%(109/128),其中他莫西芬组和乳癖散结胶囊组的完全消退率相似(χ²=0.289,P=0.591),且两组患者的疼痛缓解率亦相似,分别为84.12%(53/63)和86.15%(56/65)。

结论

多数男性乳房发育属生理性,可予以临床观察,中药(乳癖散结胶囊)不仅可以改善患者的乳房疼痛或触痛等症状,还可提高其完全消退率,且无明显不良反应。

Objective

To explore the pathologic causes,pathogenesis,and a optimal diagnostic and treatment method for gynecomastia.

Methods

From January 1999 to December 2008,268 patients with gynecomastia were treated in our hospital.Their data were analyzed comprehensively combined with document review.Chisquare test was used for the analysis of numeration data.

Results

Among the 268 patients,240 had physiological gynecomastia,and 28 had pathological gynecomastia.Acording to the pathologic causes,of the 28 pathological gynecomastia patients,12 had drug-induced gynecomastia,11 had tumor-induced gynecomastia(lung cancer in 4,gastric cancer in 2,adrenal neoplasm in 2,testicular tumor in 2,and renal-cell carcinoma in 1),and 5 patients were induced by other causes including Klinefelter's syndrome in 2,thyrotoxicosis in 1,hypothyreosis in 1 and uremia in 1.The results of follow-up showed the rate of complete regression of gynecomastia was 72.73%(56/77)in the clinical observation group,and 77.34(99/128)in drug treatment group.The curative effect had no significant difference between the tamoxifen group and the Rupisanjiejiaonang group(χ²=0.289,P=0.591),the rate of breast pain relief was 85.16%(109/128)and similar in the two groups,84.12%(53/63)in the tamoxifin group and 86.15%(56/65)in the Rupisanjiejiaonang group,respectively.

Conclusion

Most gynecomastia cases are physiological and do not need treatment.Chinese medical therapy(Rupisanjiejiaonang)not only improves breast pain and tenderness but also increases the rate of complete regression,moreover,the curative effect is not statistically different between Rupisanjiejiaonang and tamoxifen, and Rupisanjiejiaonang has no obvious side-effects.