[抗分枝杆菌药物治疗伴有瘘管的导管周围乳腺炎]

Yu Hai-jing, Wang Qi, Yang Jian-min, Lian Zhen-qiang, Zhang An-qin, Li Wen-ping, Xu Juan, Zhu Cai-xia, Gao Hong-yi, Lai You-xng

Breast Disease Center, Guangdong Women and Children Hospital of Guangzhou Medical College, Guangdong 510010, China.

Zhonghua Wai Ke Za Zhi. 2012 Nov;50(11):971-4.

OBJECTIVES

To study the etiology, clinical and pathologic characteristics of periductal mastitis with fistula and estimate the effect of anti-mycobacterial agents for periductal mastitis with fistula.

METHODS

Totally 27 patients of periductal mastitis with fistula received anti-mycobacteria drugs therapy from December 2008 to September 2011 were analyzed retrospectively. All of the patients were female. The mean age at onset was 28 years (range 15 to 40 years old). The main clinical manifestation of the 27 patients was breast fistula, including 21 patients with single fistula and 6 patients with multiple fistula. Three patients manifested with pure fistula, 14 patients with both fistula and lump, 10 patients with fistula, lump and abscess. The samples including pus or tissues of all patients were underwent bacteria culture and all patients core needle biopsy. All patients were given primary anti-mycobacteria drugs therapy, parts of patients received surgery based on the evaluation of medical treatment.

RESULTS

The common bacteria culture of all patients failed to demonstrate any causative microorganism. Four cases were selected randomly to undergo PCR of mycobacteria, only one case was identified as Massiliense in bacteria culture of mycobacteria. Twenty-seven patients with periductal mastitis with fistula were treated with anti-mycobacterial agents (isoniazid, rifampicin and ethambutol or pyrazinamide of triple oral drugs) for 1 to 3 months, the fistula of all 27 patients were closed well. Sixteen patients were treated with the agents only and cured. Eleven patients received surgical treatment after treated with the medical agents. None of the patients were given mastectomy. All patients had no reccurence until now.

CONCLUSIONS

The periductal mastitis with fistula has a closely relationship with the infection of nontuberculosis mycobacteria. Those patients could be treated with triple anti-mycobacterial agents and could also avoided mastectomy.

目的

研究伴有瘘管的导管周围乳腺炎的病因、临床及病理特征，并评估抗分枝杆菌药物对伴有瘘管的导管周围乳腺炎的治疗效果。

方法

回顾性分析2008年12月至2011年9月期间接受抗分枝杆菌药物治疗的27例伴有瘘管的导管周围乳腺炎患者。所有患者均为女性。发病时的平均年龄为28岁（范围15至40岁）。27例患者的主要临床表现为乳腺瘘管，其中单瘘管21例，多瘘管6例。3例表现为单纯瘘管，14例既有瘘管又有肿块，10例有瘘管、肿块及脓肿。对所有患者的脓液或组织样本进行细菌培养，并对所有患者进行粗针活检。所有患者均接受一线抗分枝杆菌药物治疗，部分患者根据药物治疗评估结果接受手术治疗。

结果

所有患者的常见细菌培养均未发现任何致病微生物。随机选取4例进行分枝杆菌PCR检测，仅1例在分枝杆菌细菌培养中被鉴定为马赛分枝杆菌。27例伴有瘘管的导管周围乳腺炎患者接受抗分枝杆菌药物（异烟肼、利福平、乙胺丁醇或三联口服药物吡嗪酰胺）治疗1至3个月，所有27例患者的瘘管均愈合良好。16例患者仅接受药物治疗并治愈。11例患者在接受药物治疗后接受了手术治疗。所有患者均未进行乳房切除术。所有患者至今均无复发。