探讨乳头修复术治疗哺乳期慢性乳头损伤的应用价值。

根据纳入及排除标准，纳入2015年11月至2020年6月于北京市海淀区妇幼保健院就诊的哺乳期慢性乳头损伤患者274例进行回顾性分析。根据治疗方案不同，分为3组：修复组87例，全部进行乳头修复术；敷药组92例，外敷重组人碱性成纤维细胞生长因子(rh-bFGF)药物；联合组95例，先行乳头修复术，术后外敷rh-bFGF药物。采用非参数Kruskal-Wallis H检验比较3组患者乳头损伤愈合程度及疼痛改善程度，其两两比较采用Dunn-Bonferroni检验；采用χ²检验比较治愈率和复发率的差异，两两比较采用Bonferroni校正的χ²检验。

修复组中45例患者乳头损伤完全愈合，22例好转，20例无效；敷药组中33例完全愈合，17例好转，42例无效；联合组中70例完全愈合，14例好转，11例无效，3组比较，差异有统计学意义(χ²＝32.252，P<0.001)。联合组乳头损伤愈合程度优于修复组，联合组与修复组均优于敷药组(Bonferroni校正P＝0.018、<0.001、0.014)。修复组中40例患者乳头疼痛完全消失，25例好转，22例无效；敷药组中26例疼痛完全消失，29例好转，37例无效；联合组中61例疼痛完全消失，21例好转，13例无效，3组比较，差异有统计学意义(χ²＝26.907，P<0.001)。联合组疼痛改善程度优于修复组，联合组与修复组均优于敷药组(Bonferroni校正P＝0.041、<0.001、0.026)。修复组、敷药组、联合组患者治愈率分别为44.8%(39/87)，26.1%(24/92) 55.8%(53/95)，3组比较，差异有统计学意义(χ²＝17.688，P<0.001)。修复组与联合组的治愈率均高于敷药组(χ²＝17.470、7.149, Bonferroni校正P＝0.008、<0.001),联合组与修复组比较，差异无统计学意义(χ²＝2.183, Bonferroni校正P＝0.140)。在乳头损伤治愈患者中，修复组乳头损伤复发率为28.2%(11/39)，敷药组为29.2%(7/24)，联合组为24.5%(13/53)，3组比较，差异无统计学意义(χ²＝0.247，P＝0.884)。

对于哺乳期慢性乳头损伤的患者，乳头修复术不仅可以改善乳头损伤的愈合环境，缓解乳头疼痛，还有助于外用药rh-bFGF在损伤局部发挥促进上皮、组织、神经修复的作用。

To explore the application of nipple repair surgery in the treatment of chronic nipple injury during lactation.

According to the inclusion and exclusion criteria, 274 patients with chronic nipple injury during lactation in the Haidian Maternal and Child Health Hospital from November 2015 to June 2020 were included for a retrospective analysis. Based on different treatment schemes, they were divided into 3 groups: the nipple repair group (87 cases) receiving nipple repair, the recombinant human basic fibroblast growth factor(rh-bFGF) application group (92 cases) receiving external application of drugs including rh-bFGF and the combined therapy group (95 cases) who firstly underwent nipple repair, and then applied rh-bFGF after operation. The non-parametric Kruskal-Wallis H test was used to compare the healing of nipple injury and pain improvement among three groups and the Dunn-Bonferroni test was used for pairwise comparison.χ² test was used to compare the recovery rate and recurrence rate, and Bonferroni correction of χ² test was performed for pairwise comparison.

The number of patients with complete healing of nipple injury, improvement of wound and inefficacy was 45, 22 and 20 in the nipple repair group, 33, 17 and 42 in the rh-bFGF application group, 70, 14 and 11 in the combined therapy group, indicating a significant difference (χ²=32.252, P<0.001). The healing of nipple injury in the combined therapy group was significantly better than that in the nipple repair group, and both the combinedtherapy group and the nipple repair group showed significantly better injury healing compared with the rh-bFGF application group (Bonferroni-corrected P=0.018, <0.001, 0.014). The number of patients with complete pain relief of nipples, partial relief and no relief was 40, 25 and 22 in the nipple repair group, 26, 29 and 37 in the rh-bFGF application group, 61, 21 and 13 in the combined therapy group, indicating a significant difference among three groups (χ²=26.907, P<0.001). The pain relief of nipples in the combined therapy group was significantly better than that in the nipple repair group, and both the combined therapy group and the nipple repair group showed better pain relief compared with the rh-bFGF application group (Bonferroni-corrected P=0.041, <0.001, 0.026). The recovery rate was 44.8% (39/87) in the nipple repair group, 26.1% (24/92) in the rh-bFGF application group and 55.8% (53/95)in the combined therapy group, indicating a significant difference among three groups(χ²=17.688, P<0.001). The recovery rate in the nipple repair group and the combined therapy group was significantly higher than that in the rh-bFGF application group (χ²=17.470, 7.149, Bonferroni-corrected P=0.008, <0.001), while there was no significant difference between the nipple repair group and the combined therapy group (χ²=2.183, Bonferroni-corrected P=0.140). The recurrence rate in the healed patients was 28.2% (11/39) in the nipple repair group, 29.2% (7/24) in the rh-bFGF application group and 24.5% (13/53)in the combined therapy group, indicating no significant difference among three groups (χ²=0.247, P=0.884).

For patients with chronic nipple injury during lactation, nipple repair surgery can improve the healing environment, relieve nipple pain and promote the efficacy of rh-bFGF in restoring the epithelia, tissues and nerves.