摘要】目的 探讨乳管镜检查（FDS）在乳头溢液合并乳管内占位性病变的应用价值，以提高该病的诊断水平。方法 对2012年4月至2016年6月间接受FDS检查的乳头溢液85例患者的临床资料进行回顾性分析，并与病理结果进行比较。结果85例乳头溢液中，FDS发现乳管内占位性病变70例（82.4%），其中乳腺导管癌10例，乳管内乳头状瘤51例，乳头状瘤病9例；乳管内占位性病变多表现为血性溢液（83.0%）；FDS检查的灵敏度90.0%，特异度为95.0%，符合率为94.3%；乳腺导管癌导管分级多为Ⅱ~Ⅲ级（80%）。结论 FDS对未扪及肿块的乳头溢液乳管内占位性病变具有较高的诊断价值，可明确病变部位和病变性质，有利于患者及早治疗。
Abstract Objective：To investigate the diagnosis value of fiberoptic ductoscopy (FDS) in nipple discharge combined with intra-duct space occupying lesions so as to improve diagnostic accuracy of the condition. Methods：The clinical data of 85 patients with nipple discharge who received FDS in our hospital from 2012.4 to 2016.6 were analyzed retrospectively, and the results were compared with the pathological examination. Result：In 85 patients with nipple discharge, 70(82.4%) cases of intra-duct space occupying lesions was found by FDS, including 10 cases of ductal breast cancer, 51 cases of papillomatosis, 9 cases of papilloma. Much performance of intra-duct space occupying lesions was hemorrhagic discharge (83.0%). The sensitivity and specificity of FDS was 90.0%, 95.0%, the coincidence rate was 94.3%. Duct grade of ductal carcinoma was usually Ⅱ~Ⅲ(80.0%). Conclusions: FDS has high diagnostic value of intra-duct space occupying lesions for nipple discharge without palpable mass, can definite location and characteristics of lesions, is helpful for early treatment.
[1] Zervoudis S，Iatrakis G，Economides P，et al．Nipple discharge screening[J]. Womens Health (Lond Engl)，2010，6(1) : 135-151．
[2] 王勤勇，曲文志，金光华，等．彩色多普勒超声与乳腺纤维导管镜联合应用对乳头溢液的诊断价值[J]. 中国现代普通外科进展，2011，14(4): 313-315．
[3] Tang SS, Twelves DJ, Isacke CM, et al. Mammary ductoscopy in the current management of breast disease[J]. Surg Endosc, 2011, 25(6):1712-1722.
[4] Albrecht C, Thele F, Grunwald S, et al. Nipple discharge: role of ductoscopy in comparison with standard diagnostic tests[J]. Onkologie, 2013, 36(1-2):12-16.
[5] 肖盟, 邢芳, 穆兰, 等. 乳管镜临床诊治新进展[J]. 中国肿瘤临床, 2013, 41(18): 1199-1201.
[6] 顾懿帆，周鸣，刘溦薇．纤维乳管镜在乳腺导管占位病变诊断及治疗中的应用[J]．临床和实验医学杂志，2013，12(22) : 1836-1837．
[7] 沈叶，虞贞凤，单远洲．纤维乳腺导管镜在乳头溢液疾病诊治中的应用[J]．南昌大学学报（医学版），2014，54(2) : 63-65．
[8] 侍晓辰，周仕萍．纤维乳管镜的临床应用进展[J]．中国医药，2011，6(7): 893-894．
[9] 雷莹,何建军, 李今.纤维乳管内视镜在乳头溢液性疾病诊治中的应用[J].中华普通外科杂志,2012,27(8):632-634.
[10]Kamali S, Bender O, Kamali GH, et al. Diagnostic and therapeutic value of ductoscopy in nipple discharge and intraductal proliferations compared with standard methods[J]. Breast Cancer, 2014, 21(2):154-161.
[11]郭丽英，马方婧，迪丽米娜?伊拉木．乳管镜对双乳多孔溢液乳管内占位的诊断与价值[J]．中国普通外科杂志，2011，20(5) : 512-514．
[12]Parthasarathy V，Rathnam U．Nipple discharge: an early warning sign of breast cancer[J]．Int J Prev Med，2012，3(11): 810-814．
[13]付艳，吴志琴，陈述．乳管镜在乳头溢液诊治中的临床应用价值[J]．中国普通外科杂志，2012，21(5)：573-576．
