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中华乳腺病杂志(电子版) ›› 2025, Vol. 19 ›› Issue (02) : 119 -124. doi: 10.3877/cma.j.issn.1674-0807.2025.02.010

综述

非特异性乳腺炎的诊疗进展
谢宛辰1, 殷雪东1, 李山奇1, 李欣宇1, 厉红元1, 任国胜1,()   
  1. 1. 400016 重庆医科大学附属第一医院乳腺甲状腺外科
  • 收稿日期:2024-09-19 出版日期:2025-04-01
  • 通信作者: 任国胜

Research progress in diagnosis and treatment of nonspecific mastitis

Wanchen Xie, Xuedong Yin, Shanqi Li, Xinyu Li, Hongyuan Li, Guosheng Ren()   

  • Received:2024-09-19 Published:2025-04-01
  • Corresponding author: Guosheng Ren
引用本文:

谢宛辰, 殷雪东, 李山奇, 李欣宇, 厉红元, 任国胜. 非特异性乳腺炎的诊疗进展[J/OL]. 中华乳腺病杂志(电子版), 2025, 19(02): 119-124.

Wanchen Xie, Xuedong Yin, Shanqi Li, Xinyu Li, Hongyuan Li, Guosheng Ren. Research progress in diagnosis and treatment of nonspecific mastitis[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2025, 19(02): 119-124.

非特异性乳腺炎是一类无明确致病因素的急慢性乳腺炎症,主要包括浆细胞性乳腺炎、特发性肉芽肿性乳腺炎、乳腺导管扩张症等。本文总结了非特异性乳腺炎的潜在病因、诊断及治疗进展。研究表明,高泌乳素血症、吸烟、激素药物、自身免疫异常及α1抗胰蛋白酶缺乏等因素可能与发病相关,但具体机制仍待阐明。诊断需依赖影像学联合病理学检查,并需与IgG4相关性乳腺炎、结核性乳腺炎等鉴别。治疗目前尚缺乏统一标准,早期以糖皮质激素、抗生素及微创引流为主,复杂病例需手术切除或联合免疫调节治疗,但复发率仍较高。未来研究需深入探索分子机制、完善诊断标准并建立循证治疗策略,以降低误诊风险、改善患者预后。

表1 IgG4-RM和IGM的鉴别诊断标准
[1]
肖蔷, 张超杰. 非哺乳期乳腺炎的现代研究进展[J]. 医学与哲学(B), 2013, 34(3): 8-13.
[2]
Palmieri A, D'Orazi V, Martino G, et al. Plasma cell mastitis in men:a single-center experience and review of the literature[J]. In Vivo,2016, 30(6): 727-732.
[3]
Kessler E, Wolloch Y. Granulomatous mastitis: A lesion clinically simulating carcinoma[J]. Am J Clin Pathol, 1972, 58(6): 642-646.
[4]
Diesing D, Axt-Fliedner R, Hornung D, et al. Granulomatous mastitis[J]. Arch Gynecol Obstet, 2004, 269(4): 233-236.
[5]
Altintoprak F, Kivilcim T, Ozkan OV. Aetiology of idiopathic granulomatous mastitis[J]. World J Clin Cases, 2014, 2(12): 852-858.
[6]
Rahal RM, de Freitas-Júnior R, Paulinelli RR. Risk factors for duct ectasia[J]. Breast J, 2005, 11(4): 262-265.
[7]
Majumdar A, Mangal NS. Hyperprolactinemia[J]. J Hum Reprod Sci,2013, 6(3): 168-175.
[8]
Peters F, Schuth W. Hyperprolactinemia and nonpuerperal mastitis(duct ectasia)[J]. JAMA, 1989, 261(11): 1618-1620.
[9]
Nikolaev A,Blake CN,Carlson DL.Association between hyperprolactinemia and granulomatous mastitis[J]. Breast J, 2016, 22(2): 224-231.
[10]
杨静, 崔俊芳, 兰丽珍. 高泌乳素血症的研究进展[J]. 华西医学,2018, 33(5): 509-512.
[11]
Vestergaard P, Rejnmark L, Weeke J, et al. Smoking as a risk factor for graves'disease,toxic nodular goiter,and autoimmune hypothyroidism[J]. Thyroid, 2002, 12(1): 69-75.
[12]
Prummel MF, Wiersinga WM. Smoking and risk of graves' disease[J].JAMA, 1993, 269(4): 479-482.
[13]
Arnson Y, Shoenfeld Y, Amital H. Effects of tobacco smoke on immunity, inflammation and autoimmunity[J]. J Autoimmun, 2010,34(3): J258-265.
[14]
Bundred NJ, Dover MS, Aluwihare N, et al. Smoking and periductal mastitis[J]. BMJ, 1993, 307(6907): 772-773.
[15]
Al-Khaffaf B, Knox F, Bundred NJ. Idiopathic granulomatous mastitis:a 25-year experience[J]. J Am Coll Surg, 2008, 206(2): 269-273.
[16]
Hussain AN, Policarpio C, Vincent MT. Evaluating nipple discharge[J]. Obstet Gynecol Surv, 2006, 61(4): 278-283.
[17]
Boufettal H, Essodegui F, Noun M, et al. Idiopathic granulomatous mastitis: a report of twenty cases[J]. Diagn Interv Imaging, 2012,93(7-8): 586-596.
[18]
Amsterdam JD, Garcia-España F, Goodman D, et al. Breast enlargement during chronic antidepressant therapy[J]. J Affect Disord,1997, 46(2): 151-156.
[19]
Yukawa M, Watatani M, Isono S, et al. Management of granulomatous mastitis: a series of 13 patients who were evaluated for treatment without corticosteroids[J]. Int Surg, 2015, 100(5): 774-782.
[20]
Holla S, Amberkar MB, Kamath A, et al. Risperidone induced granulomatous mastitis secondary to hyperprolactinemia in a nonpregnant woman-a rare case report in a bipolar disorder[J]. J Clin Diagn Res, 2017, 11(1): Fd01-fd03.
[21]
DeHertogh DA, Rossof AH, Harris AA, et al. Prednisone management of granulomatous mastitis[J]. N Engl J Med, 1980, 303(14): 799-800.
[22]
Akbulut S, Yilmaz D, Bakir S. Methotrexate in the management of idiopathic granulomatous mastitis: review of 108 published cases and report of four cases[J]. Breast J, 2011, 17(6): 661-668.
[23]
Kim J, Tymms KE, Buckingham JM. Methotrexate in the management of granulomatous mastitis[J]. ANZ J Surg, 2003, 73(4): 247-249.
[24]
Ozel L, Unal A, Unal E, et al. Granulomatous mastitis: is it an autoimmune disease? Diagnostic and therapeutic dilemmas[J]. Surg Today, 2012, 42(8): 729-733.
[25]
Schwartz IS, Strauchen JA. Lymphocytic mastopathy. An autoimmune disease of the breast?[J]. Am J Clin Pathol, 1990, 93(6): 725-730.
[26]
Erhan Y, Veral A, Kara E, et al. A clinicopthologic study of a rare clinical entity mimicking breast carcinoma: Idiopathic granulomatous mastitis[J]. Breast, 2000, 9(1): 52-56.
[27]
Koksal H. Human leukocyte antigens class i and ii in patients with idiopathic granulomatous mastitis[J]. Am J Surg, 2019, 218(3):605-608.
[28]
Strick L. Alpha-1 antitrypsin deficiency[J]. Calif Med, 1971, 115(4): 46.
[29]
Janciauskiene SM, Bals R, Koczulla R, et al. The discovery of α1-antitrypsin and its role in health and disease[J]. Respir Med, 2011,105(8): 1129-1139.
[30]
Zhou Y, Feng BJ, Yue WW, et al. Differentiating non-lactating mastitis and malignant breast tumors by deep-learning based ai automatic classification system: a preliminary study[J]. Front Oncol,2022, 12: 997306.
[31]
Hu J, Huang X. Combining ultrasonography and mammography to improve diagnostic accuracy of plasma cell mastitis[J]. J Xray Sci Technol, 2020, 28(3): 555-561.
[32]
Tan H, Li R, Peng W, et al. Radiological and clinical features of adult non-puerperal mastitis[J]. Br J Radiol, 2013, 86(1024):20120657.
[33]
Ming J, Meng G, Yuan Q, et al. Clinical characteristics and surgical modality of plasma cell mastitis: analysis of 91 cases[J]. Am Surg,2013, 79(1): 54-60.
[34]
Mohammed AA. Mammary duct ectasia in adult females; risk factors for the disease, a case control study[J]. Ann Med Surg (Lond), 2021,62: 140-144.
[35]
Katz G, Stone JH. Clinical perspectives on IGG 4-related disease and its classification[J]. Annu Rev Med, 2022, 73: 545-562.
[36]
Ogura K, Matsumoto T, Aoki Y, et al. IGG 4-related tumour-forming mastitis with histological appearances of granulomatous lobular mastitis:comparison with other types of tumour-forming mastitis[J].Histopathology, 2010, 57(1): 39-45.
[37]
Allen SG, Soliman AS, Toy K, et al. Chronic mastitis in egypt and morocco: differentiating between idiopathic granulomatous mastitis and IGG 4-related disease[J]. Breast J, 2016, 22(5): 501-509.
[38]
Erivwo P, Turashvili G. Pathology of IGG 4-related sclerosing mastitis[J]. J Clin Pathol, 2021, 74(8): 475-482.
[39]
Wu JM, Turashvili G. Cystic neutrophilic granulomatous mastitis: an update[J]. J Clin Pathol, 2020, 73(8): 445-453.
[40]
Uçan ES, Alpaydın A, Gündüz Karayazı D, et al. Tuberculous mastitis: a masquerading face of granulomatous mastitis[J]. Tuberk Toraks, 2022, 70(3): 271-278.
[41]
韦丽光, 韩猛. 非哺乳期乳腺炎的诊疗进展[J]. 实用医学杂志,2022, 38(9): 1161-1165.
[42]
斯岩, 王水, 肇毅. 乳管镜诊治乳头溢液980例分析[J]. 江苏医药, 2012, 38(21): 2531-2533.
[43]
Azlina AF, Ariza Z, Arni T, et al. Chronic granulomatous mastitis:diagnostic and therapeutic considerations[J]. World J Surg, 2003, 27(5): 515-518.
[44]
Costa Morais Oliveira V, Cubas-Vega N, López Del-Tejo P, et al.Non-lactational infectious mastitis in the americas: a systematic review[J]. Front Med (Lausanne), 2021, 8: 672513.
[45]
石盼, 王芳, 红华, 等. 脓肿期浆细胞性乳腺炎超声引导穿刺抽液与负压封闭引流术的治疗对比[J]. 中国超声医学杂志, 2023, 39(4): 384-387.
[46]
徐玲, 潘华锋. 微创旋切术、开放手术、穿刺抽液术治疗脓肿期浆细胞性乳腺炎的疗效分析[J]. 临床外科杂志, 2023, 31(3): 223-226.
[47]
郑洁莹, 仲文莉, 王玥琦, 等. 火针联合浆乳二号方治疗非哺乳期乳腺炎脓肿期临床研究[J]. 安徽中医药大学学报, 2024, 43(6):13-17.
[48]
瞿文超, 万华, 吴雪卿, 等. 分次手术治疗非哺乳期乳腺炎的临床疗效观察[J]. 外科理论与实践, 2024, 29(5): 446-451.
[49]
朴明姬, 许斌, 杜金柱, 等. 清热活血解毒方联合改良挂线术治疗瘘管期浆细胞性乳腺炎临床研究[J]. 陕西中医, 2022, 43(3):305-308.
[50]
杨心茹, 左禧萌, 史晓光. 预防性使用皮瓣转移乳头乳晕成形术在肉芽肿性小叶性乳腺炎手术中的应用评价[J]. 中国现代手术学杂志, 2024, 28(1): 22-28.
[51]
买莉, 王佳陪. 手术切除方法在非哺乳期乳腺炎治疗中的应用价值[J]. 黑龙江中医药, 2023, 52(4): 36-38.
[52]
周飞, 刘璐, 余之刚. 非哺乳期乳腺炎诊治专家共识[J]. 中国实用外科杂志, 2016, 36(7): 755-758.
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