目的

评价纤维乳管镜（FDS）对伴有乳头溢液的乳腺导管内占位性病变的诊治的应用价值。

方法

2005年9月至2009年12月本院采用FDS检查乳头溢液患者523 例，发现乳腺导管内占位性病变209 例（39.96% ）。 209 例乳腺导管内占位性病变患者中，193 例良性病变，均行手术治疗；16 例恶性病变（乳头状瘤恶变6 例，导管原位癌3 例，浸润性导管癌6 例，乳腺导管内乳头状瘤伴钙化、乳腺腺病重度非典型增生、局部癌变1 例）分别行保留乳房手术5 例，单纯乳腺切除术3 例，乳腺癌改良根治术4 例，乳腺癌改良根治术加假体即时置入术4 例； 所有手术采用FDS 结合扩张探针定位法。 所有病例均经病理证实。 随访时间5～56 个月（中位随访时间25 月）。

结果

193 例良性病变患者全部治愈，除2 例患者失访外，其余无复发。 16 例恶性病变患者经治疗后，未发现复发、转移及死亡。

结论

应用FDS 诊断乳腺导管内占位性病变有临床参考价值，辅助手术定位准确，有助于获得满意的手术治疗效果。

Objective

To evaluate the application value of fiberoptic ductoscopy in the treatment of intraductal occupying lesions with nipple discharge.

Methods

From September 2005 to December 2009 a total of 523 nipple discharge patients were examined using fiberoptic ductoscopy （FDS） in our hospital，among them 209 patients were found suffering intraductal space occupying lesions with nipple discharge，with diagnostic rate of 39.96% .Of the 209 patients， 193 had benign lesions and were treated with ductoscopically guided duct excision， and 16 patients had malignant lesions， including intraductal papilloma canceration in 6 cases， ductal carcinoma in situ in 3 cases， infiltrating duct carcinoma in 6 cases and intraductal papilloma with calcification， severe atypical hyperplasia of breast adenosis and local canceration in 1 case， and were managed with breast conserving surgery in 5 cases， simple mastectomy in 3， modified radical mastectomy in 4 and modified radical mastectomy plus immediate prosthesis implantation in 4.FDS plus probe location method was used for all operations.All patients were pathologically confirmed.The follow-up time was 5—56 months with median time of 25 months.

Results

The 193 patients with benign lesions were all cured， and the follow-up showed that except 2 patients lost to followup， the rest had no recurrence.For the 16 patients with malignant lesions， no recurrence， metastasis or death was found.

Conclusions

FDS is of clinical value in diagnosing intraductal occupying lesions with nipple discharge， and help to obtain accurate location and satisfactory therapeutic effect.