Clinical Analysis Of 200 Cases Of Benign Nipple Discharge By Surgery Therapy

Research background In recent years,breast disease has become an increasingly serious impact on women's physical and mental health. In many western countries,the incidence of gynecologic tumors is the highest.Even more, breast cancer has become the first one of female's malignant tumors in some major cities in China,such as Beijing,Guangzhou. The history of post- menop- ausal,the history of abortion,contraception drug history,family history of breast cancer,bad mood,adverse events,poor emotion regulation,labor intensity,and ages are prominent risk factors of women's breast cancer. So,how to prevent,as well as early detection,early diagnosis and treatment of breast cancer has become the focus of worldwide. And early detection and the treatment of breast disease are important ways to prevent the proliferation of breast cancer and to eliminate breast cancer. Nipple discharge (Nipple Discharge,ND) is one of the three symptoms of breast disease,accounting for 3% ~ 8% of all the breast diseases.It is only less than breast lumps and breast pain.And ND is the duct lesions of early performance. Nipple discharge can catch patients'attention easily,which often make patients come to hospital as a prominent chief complaint. A number of simple nipple discharge can be regarded as a early signal of breast cancer.So the early diagnosis and treatment are very important.At present,the diagnosis and treatment of nipple discharge are developing and improving continuously,in which surgery is not only an important method of diagnosis but also an important means of treatment. However,due to the different causes and ranges of nipple discharge,there are not many clinical surgery methods which have been determined. So,inaccurated location and recurrence easily appeared. Besides,many patients after surgery therapy have some shortage in breast's appearance,such as the inversion of nipple,the migration of the nipple's location .Therefore,since 2002,we use galactography positioning and partial mastecto- mmy,combining with the nipple and the gland forming to treat the benign nipple discharge in our hospital. We use those methods in orde to meet the following requirements: 1. Locate accurately,removal the scope of the disease as far as possible; 2. Make the appearance of the breast after surgery beautiful.Objective To discuss the recurrence and the appearance of the breast after surgery on patiens with benign nipple discharge.Method A retrospective study and clinic follow-up research on 200 patients with benign nipple discharge during March of 2002 to March of 2008 was performed. Those were all treated by surgery way. 200 patients all were not pregnancy or breast-feeding women,≥30 years old,besides,they had been married and given birth. We used galactography on the 200 cases before the operation,injected Meilan with the blunt to instruct and locate during the operation,removled the blue range with partial mastcctomy,then,formed the nipple and the gland,sewed up the wound of the skin percutaneously with the absorbable suture.At the end,the nipple was made to keep upright when we coveraged outside the dressing.Results:1.The results of pathological examination200 cases in this group were confirmed by intraoperative frozen section and paraffin section. There were intraductal papilloma accounting for 68.0%,breast intraductal papillomatosis (BIDP) for5.5%,simple duct ectasia for 7.0%,duct ectasia with inflammation for 9.5%,breast cystic hyperplasia for 10.0%。Intraductal papilloma and BIDP totally account for 73.5 % of all cases. And the galactography of all cases in this group clearly showed expanded duct, ductal filling defect or duct disruption.NOTE: Nipple discharge with galactography which shows expanded duct, ductal filling defect or duct disruption is one of the indications of the surgical treatment.2. The relationship between the nature of the nipple discharge and the nature of the pathologyThe bloody discharge (including the bloody discharge and the bloody serous discharge,the same below)is more than others,accounting for 65.5%, In which,intraductal papilloma and BIDP totally account for 87.0 %. NOTE: Intraductal papilloma and BIDP accounted for the majority of cases with bloody discharge. Serous discharge account for 21.0 %,in which,those caused by intraductal papilloma and BIDP totally account for 59.5%. NOTE:The serous discharge caused by intraductal papilloma and BIDP can be easily founded.3. The relationship between ages and the pathologyThe average age of patients in this group is 44 years old; the average age of those with inntraductal papilloma is 41,and that of those with BIDP is 52. Because there are some conditions on ages of these cases,the relationship between ages and the pathology are not statistically significant.4. The relationship among the nature of the discharge,the lump combined or not and the pathology .There are nipple discharge combined with the lump in 44 cases(22%), nipple discharge combined without the lump in 156 cases(78%).NOTE:Most of the benign nipple discharge are not combined with the lump.5. Follow-up200 cases of this group were followed for 1 to 6 years through out-patient review,telephone and so on. All the patients present without the recurrence of the nipple discharge and have beautiful appearance of the breast.Conclusion: 1. Nipple discharge with galactography which shows expanded duct, ductal filling defect or duct disruption is one of the indications of the surgical treatment.2. Intraductal papilloma and BIDP accounted for the majority of cases with bloody discharge. The serous discharge caused by intraductal papilloma and BIDP can be easily founded.3. Most of the benign nipple discharge are not combined with the lump.5. 4.The treatment of patients with the benign nipple discharge by galacto- graphy positioning and partial mastectomy is effective,and,there are no recurrence after operation.6.Compared with others,the surgical procedures in this group make patients avoid missing lesions.7. Because the nipple and the gland were formed,patients after the operation in this group all have a good appearance of the breast, without the retraction and migration of the nipple,local depression of the brest and so on.