| Background:Nipple discharge is one of the three common main symptoms of breast disease,and its incidence is about 5%.There are many kinds of nipple discharge in clinic,including milk-like,polychromatic viscosity,purulent,water,serous,serous and bloody,of which 80%and 90%of nipple discharge is caused by benign causes.This mainly includes mammary duct inflammation,mammary duct ectasia,intraductal papilloma and breast hyperplasia.There is a big difference between traditional Chinese medicine and western medicine in the treatment of nipple discharge.For intraductal space-occupying lesions,surgery is the main treatment in western medicine.In clinical practice,it has been found that most benign non-tumor nipple discharge can be relieved or cured by conservative treatment,including systemic treatment and local drug therapy.The most representative kind of local treatment is the drug irrigation or perfusion treatment of overflow milk duct under fiberoptic duct endoscope,and the local topical treatment of traditional Chinese medicine can also be seen.With the increasing popularity of fiberoptic duct endoscope,people have a deeper and deeper understanding of non-tumor space-occupying nipple discharge.The local drug infusion of breast duct is economical,convenient and effective,but its curative effect is limited.and there is a certain probability of repetition in some patients after using this therapy.In terms of systemic treatment,there is no better method in modern western medicine.Traditional Chinese medicine has certain advantages in the treatment of nipple discharge.According to clinical experience,non-operative treatment of nipple discharge caused by non-space-occupying benign breast lesions can achieve a certain therapeutic effect.The author's department used oral traditional Chinese medicine syndrome differentiation treatment combined with fiberoptic duct endoscopic drug infusion in the treatment of nipple discharge of liver depression and spleen deficiency and achieved a certain curative effect,to a certain extent,improved the therapeutic effect and cure rate of non-tumorous nipple discharge of liver depression and spleen deficiency.However,its specific curative effect needs to be further verified by clinical practice.Objective:To observe the changes of nipple discharge,inner wall of breast duct and TCM symptoms in patients with nipple discharge of liver depression and spleen deficiency type after treatment,to evaluate the clinical efficacy of Ruqining decoction combined with drug infusion under fiberoptic ductoscopy in the treatment of nipple discharge of liver depression and spleen deficiency type.To provide a more optimized scheme for the treatment of nipple discharge of liver depression and spleen deficiency.Methods:Collected patients with nipple discharge who met the inclusion criteria in the outpatient clinic of the Breast Department of Dongfang Hospital from January 01,2019 to August 1,2020.According to the sample size calculation formula,considering the drop-off rate of 20%,48 cases of income were randomly divided into Ruqining decoction combined with drug perfusion treatment group under fiberoptic duct endoscope(experimental group)and control group(control group).There were 24 patients in each group.The treatment time was 3 weeks.A prospective control study database was established to evaluate and compare the changes of nipple discharge,breast duct inner wall and TCM symptoms of the two treatments on the 1st,8th,15th and 22nd day of treatment.The patients were followed up one month after the end of treatment.Results:(1)After 3 weeks of treatment,the experimental group was cured in 8 cases,markedly effective in 7 cases,effective in 7 cases and ineffective in 2 cases.The total effective rate was 91.67%.In the control group,10 cases were cured,2 cases were markedly effective,4 cases were effective,8 cases were ineffective,and the total effective rate was 66.67%.There was a statistically significant difference in the total effective rate between the two groups in the treatment of nipple discharge of liver depression and spleen deficiency.It can be considered that the curative effect of Ruqining decoction combined with drug perfusion under mammary duct endoscope is better than that of drug perfusion under mammary duct endoscope.(2)The experimental group was significantly better than the control group in promoting the reduction of nipple discharge from the 15th day of treatment,and the difference between the two groups was statistically significant.Microscopic observation showed that the two groups had a certain curative effect in promoting wall congestion and reducing inflammatory flocs compared with each group before treatment,but there was no significant difference between the two groups.(3)The experimental group was significantly better than the control group in improving the symptoms of Nagu discomfort,irritability,insomnia and dreaminess,chest tightness and hypochondriac pain,anxiety and depression,and the difference between the two groups was statistically significant.(4)There were no complications and adverse reactions in both groups(5)There was no recurrence in the two groups after 1 month follow-up.Conclusion:(1)Ruqining decoction combined with drug infusion under fiberoptic ductoscopy is effective in the treatment of nipple discharge of liver depression and spleen deficiency,which is better than that of drug perfusion under fiberoptic ductoscopy.(2)Ruqining decoction combined with drug perfusion under fiberoptic duct endoscope is safe and reliable in the treatment of nipple discharge of liver depression and spleen deficiency,and there are no adverse reactions and complications at present.(3)Ruqining decoction combined with drug infusion under fiberoptic ductoscopy in the treatment of nipple discharge of liver depression and spleen deficiency type had no recurrence during short-term follow-up,which can be used as one of the effective schemes for the treatment of liver depression and spleen deficiency nipple discharge. |
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