A Method of "Neo-canalization" for a Mammary Fistula Resulting from Nippleplasty-A Case Report

運用“管路再造”手術來治療乳頭整形術後併發乳腺瘻管－病例報告

蘇皇銓(Huang-Chuan Sue) ； 黃文成(Wen-Chen Huang) ； 董光義(Kwang-Yi Tung) ； 游家孟(Chia-Meng Yu)

《臺灣整形外科醫學會雜誌》 19卷1期 (2010/03) Pp. 65-71

https://doi.org/10.7096/TJTSPS.201003.0065

摘要

背景：
乳腺瘻管是乳頭整形術後少見的併發症之一。它是乳腺管和皮膚之間存在的異常通道。由於具有反覆發生的特性，經常困擾著病人以及治療者。儘管有許多文獻報導它和乳暈下膿瘍有關，但其發生的原因以及處理的方式仍然眾說紛紜。
目的及目標：
處理乳腺瘻管傳統的標準做法是瘻管切開術與瘻管切除術，但這些方式會造成乳頭及乳暈構造的破壞及變形。因此，我們設計運用“管路再造”的手術方式來處理乳腺瘻管，以達到適當引流並避免組織過度的破壞。
材料及方法：
此病人接受兩次兩側乳頭整形術，後來右乳頭併發乳腺瘻管，瘻管開口位於乳頭基部3點鐘及9點鐘方向，手術中我們先將鼻淚矽質軟管穿過兩個瘻管開口，再用18號及24號針頭當引導，分別由瘻管兩側開口製造新的人工瘻管通至乳頭頂端；再將軟管兩端穿過人工瘻管達於乳頭的頂端，軟管兩端打結固定。矽質軟管留置6個月，待其形成成熟之新管道。
結果：
病人在術後1週，乳頭頂端分泌物明顯減少，經2 週後原來的瘻管開口完全癒合。我們在半年後拔除矽質軟管，病人追蹤兩年並沒有復發的情況。
結論：
“管路再造＂和傳統的手術方式相比，所造成的組織破壞較少，故可維持較佳的外觀。此術式提供了一個治療乳腺瘻管有效的新方法。

並列摘要

Background:
Mammary fistula is a rare complication resulting from nippleplasty. It is an abnormal communication between the lactiferous ducts and the breast skin. Multiple recurrences of subareolar abscess or non-healing chronic fistulas at the edge of the areola are frequently frustrating problems for both the patient and the physician. Despite numerous reports describing the association between chronic subareolar abscess and mammary fistulas, the entity remains unclear and the management is not yet standardized.
Aim and Objectives:
Traditional surgeries for mammary fistula include fistulotomy and total excision of the involved lactiferous ducts. However, these invasive methods may result in prominent distortion of the nipple-areolar complex. We designed a minimal destructive method in dealing with a mammary fistula to get a better curative and cosmetic result.
Materials and Methods:
A 30-year-old female patient received two times of bilateral nippleplasty for inverted nipples. After the operations, a mammary fistula occurred at the right nipple base. The openings of the fistula were located in the 3 and 9 o'clock directions. At operation, a silicon nasolacrimal stent was placed through the fistula from one external opening to the next. Then a 24-gauge needle was used to make a new tract from one of the fistulous openings to the top of the nipple. The 24-gauge needle was then replaced with an 18-gauge needle inserted from the opposite direction. The one end of the nasolacrimal stent was guided to the top of the nipple through the 18-gauge needle. The same procedure was applied to create another new tract from the other fistulous opening to the top of the nipple. Finally, the two ends of the nasolacrimal stent were knotted. The stent was left for 6 months to let the new canal achieve maturation.
Results:
Postoperatively, discharge from the ends of the stent reduced significantly in one week. The openings of the original fistula healed completely within two weeks. The nasolacrimal stent was removed 6 months after the surgery. There was no recurrence of the fistula within two years of follow-up. The shape of the nipple-areolar complex was preserved well.
Conclusion:
Compared with traditional procedures, this new method achieves a good cosmetic result with minimal distortion of the nipple-areolar complex. It is an effective alternative for management of mammary fistulas.

並列關鍵字

mammary fistula ； lactiferous duct obstruction ； subareolar abscess ； nippleplasty