乳(ru)腺(xian)(xian)(xian)纖(xian)(xian)(xian)維(wei)(wei)腺(xian)(xian)(xian)瘤(liu)(liu)(liu)(liu)是(shi)(shi)由腺(xian)(xian)(xian)上(shang)(shang)皮(pi)和纖(xian)(xian)(xian)維(wei)(wei)組(zu)(zu)織(zhi)兩(liang)種成(cheng)(cheng)(cheng)分(fen)(fen)混合(he)組(zu)(zu)成(cheng)(cheng)(cheng)的(de)良性(xing)(xing)腫瘤(liu)(liu)(liu)(liu),好發(fa)于(yu)青(qing)年女性(xing)(xing),與患者體(ti)內性(xing)(xing)激素水平失衡(heng)有關。對本病(bing)的(de)認識還有腺(xian)(xian)(xian)纖(xian)(xian)(xian)維(wei)(wei)瘤(liu)(liu)(liu)(liu)、腺(xian)(xian)(xian)瘤(liu)(liu)(liu)(liu)之稱(cheng)(cheng)(cheng),是(shi)(shi)由于(yu)構(gou)成(cheng)(cheng)(cheng)腫瘤(liu)(liu)(liu)(liu)的(de)纖(xian)(xian)(xian)維(wei)(wei)成(cheng)(cheng)(cheng)分(fen)(fen)和腺(xian)(xian)(xian)上(shang)(shang)皮(pi)增生程度的(de)不同所致。當腫瘤(liu)(liu)(liu)(liu)構(gou)成(cheng)(cheng)(cheng)以腺(xian)(xian)(xian)上(shang)(shang)皮(pi)增生為(wei)(wei)(wei)主,而纖(xian)(xian)(xian)維(wei)(wei)成(cheng)(cheng)(cheng)分(fen)(fen)較(jiao)(jiao)少時稱(cheng)(cheng)(cheng)為(wei)(wei)(wei)纖(xian)(xian)(xian)維(wei)(wei)腺(xian)(xian)(xian)瘤(liu)(liu)(liu)(liu);若(ruo)纖(xian)(xian)(xian)維(wei)(wei)組(zu)(zu)織(zhi)在腫瘤(liu)(liu)(liu)(liu)中占多數(shu),腺(xian)(xian)(xian)管(guan)成(cheng)(cheng)(cheng)分(fen)(fen)較(jiao)(jiao)少時,稱(cheng)(cheng)(cheng)為(wei)(wei)(wei)腺(xian)(xian)(xian)纖(xian)(xian)(xian)維(wei)(wei)瘤(liu)(liu)(liu)(liu);腫瘤(liu)(liu)(liu)(liu)組(zu)(zu)織(zhi)由大量腺(xian)(xian)(xian)管(guan)成(cheng)(cheng)(cheng)分(fen)(fen)組(zu)(zu)成(cheng)(cheng)(cheng)時,則稱(cheng)(cheng)(cheng)為(wei)(wei)(wei)腺(xian)(xian)(xian)瘤(liu)(liu)(liu)(liu)。上(shang)(shang)述三種分(fen)(fen)類只(zhi)是(shi)(shi)病(bing)理形(xing)(xing)態學方面的(de)差異,其臨(lin)床表現、治療及預(yu)后(hou)并無不同,故統稱(cheng)(cheng)(cheng)為(wei)(wei)(wei)纖(xian)(xian)(xian)維(wei)(wei)腺(xian)(xian)(xian)瘤(liu)(liu)(liu)(liu)。乳(ru)腺(xian)(xian)(xian)纖(xian)(xian)(xian)維(wei)(wei)腺(xian)(xian)(xian)瘤(liu)(liu)(liu)(liu)好發(fa)于(yu)乳(ru)房(fang)外上(shang)(shang)象限(xian),呈圓形(xing)(xing)或卵圓形(xing)(xing),臨(lin)床多見1~3cm,生長緩慢,妊娠或哺乳(ru)期時可急驟(zou)增長。極(ji)少數(shu)青(qing)春期發(fa)生的(de)纖(xian)(xian)(xian)維(wei)(wei)腺(xian)(xian)(xian)瘤(liu)(liu)(liu)(liu)可在短時間內迅速增大,直徑可達8~10cm,稱(cheng)(cheng)(cheng)為(wei)(wei)(wei)巨大纖(xian)(xian)(xian)維(wei)(wei)腺(xian)(xian)(xian)瘤(liu)(liu)(liu)(liu),仍屬(shu)良性(xing)(xing)腫瘤(liu)(liu)(liu)(liu)。纖(xian)(xian)(xian)維(wei)(wei)腺(xian)(xian)(xian)瘤(liu)(liu)(liu)(liu)惡(e)變成(cheng)(cheng)(cheng)纖(xian)(xian)(xian)維(wei)(wei)肉瘤(liu)(liu)(liu)(liu)或乳(ru)腺(xian)(xian)(xian)癌者極(ji)少見,不到1%。
卵巢(chao)功(gong)能旺盛(sheng),雌(ci)激(ji)素(su)(su)水平(ping)過高,調節失衡(heng),加之患者對雌(ci)激(ji)素(su)(su)反應敏(min)感,在(zai)(zai)雌(ci)激(ji)素(su)(su)的長期刺激(ji)下,引起乳(ru)腺腺上皮組織和纖(xian)維(wei)組織過度增(zeng)生(sheng),結(jie)構紊亂,形(xing)成腫(zhong)瘤。由于乳(ru)腺纖(xian)維(wei)腺瘤與性激(ji)素(su)(su)分(fen)泌旺盛(sheng)有關(guan),故此(ci)多發生(sheng)在(zai)(zai)青年女性,月經來潮前(qian)或絕經后婦女少見(jian)。
主要為(wei)(wei)乳房(fang)無(wu)痛性腫(zhong)塊(kuai),很少(shao)伴(ban)有(you)(you)乳房(fang)疼痛或乳頭(tou)溢液。腫(zhong)塊(kuai)往往是(shi)無(wu)意中、洗澡時,或體檢(jian)中被發(fa)現。單發(fa)腫(zhong)塊(kuai)居多(duo),亦可多(duo)發(fa),也可兩側(ce)乳房(fang)同時或先后觸及腫(zhong)塊(kuai)。多(duo)為(wei)(wei)圓形或橢圓形,直徑常為(wei)(wei)1~3cm,亦有(you)(you)更小或更大者,偶可見巨大者。境(jing)界清(qing)楚(chu),邊緣(yuan)整齊(qi),表面光滑(hua),富(fu)有(you)(you)彈性,無(wu)壓痛,活動度(du)較(jiao)大,與(yu)皮膚無(wu)粘連。
1.彩超
能顯示(shi)乳房各層次結構及腫(zhong)(zhong)塊(kuai)(kuai)形(xing)態、大小及回聲(sheng)狀況(kuang)。乳腺纖維(wei)腺瘤彩(cai)超多(duo)為(wei)圓(yuan)形(xing)、卵圓(yuan)形(xing)均勻低回聲(sheng)腫(zhong)(zhong)物(wu),多(duo)可見光滑(hua)清晰的包膜回聲(sheng),腫(zhong)(zhong)塊(kuai)(kuai)后方回聲(sheng)正常或(huo)(huo)輕微(wei)增強,可見側方聲(sheng)影,腫(zhong)(zhong)塊(kuai)(kuai)內可見伴聲(sheng)影的粗大鈣化。彩(cai)色多(duo)普(pu)勒顯示(shi)腫(zhong)(zhong)塊(kuai)(kuai)內多(duo)無血流信號或(huo)(huo)見少量血流信號,RI<0.7。
2.乳腺X線攝影
青(qing)春期女孩,致密(mi)型(xing)乳腺(xian),不適宜進(jin)行乳腺(xian)X線(xian)攝影。中年及(ji)以(yi)上婦(fu)女乳腺(xian)X線(xian)片(pian)纖維腺(xian)瘤(liu)表現為圓形(xing)、卵圓形(xing)腫塊(kuai),也可(ke)(ke)呈(cheng)分葉狀(zhuang),直徑多(duo)為1~3cm,邊緣光(guang)滑清楚(chu),與(yu)等(deng)體(ti)積的(de)(de)正常腺(xian)體(ti)比(bi)較,腫塊(kuai)呈(cheng)等(deng)或(huo)稍高密(mi)度(du),周(zhou)圍可(ke)(ke)有低密(mi)度(du)暈環。部分病(bing)灶(zao)內(nei)可(ke)(ke)見鈣化,鈣化多(duo)位于(yu)腫塊(kuai)中心或(huo)邊緣,多(duo)呈(cheng)粗(cu)顆粒狀(zhuang)、樹枝(zhi)狀(zhuang)或(huo)斑點狀(zhuang),也可(ke)(ke)相互融合成(cheng)大(da)塊(kuai)狀(zhuang),占據腫塊(kuai)大(da)部或(huo)全部,與(yu)乳腺(xian)癌的(de)(de)成(cheng)簇(cu)沙粒樣鈣化灶(zao)不同。
3.乳(ru)腺病灶活檢(jian)
根據病史、體檢或影像學檢查難以鑒(jian)別的乳腺腫塊,可采取穿刺或手術(shu)切除的方法,進行組織病理學檢查,明確(que)診斷。
乳(ru)房位于(yu)體表,典型的(de)乳(ru)腺(xian)(xian)(xian)纖(xian)維腺(xian)(xian)(xian)瘤相對(dui)容(rong)易診(zhen)斷。青少年女(nv)性,無(wu)(wu)意(yi)中(zhong)或體檢中(zhong)發現乳(ru)房無(wu)(wu)痛(tong)性腫(zhong)塊1~3cm,圓形或卵圓形,與周(zhou)圍(wei)無(wu)(wu)粘連,活動度大,觸診(zhen)有滑脫感(gan);生長緩慢(man),與月(yue)經(jing)周(zhou)期無(wu)(wu)關;臨(lin)床可(ke)考慮為乳(ru)腺(xian)(xian)(xian)纖(xian)維腺(xian)(xian)(xian)瘤。但對(dui)于(yu)妊娠后,特別是絕經(jing)后婦(fu)女(nv),乳(ru)房發現無(wu)(wu)痛(tong)性腫(zhong)塊,要提高警(jing)惕,不要輕(qing)易診(zhen)斷乳(ru)腺(xian)(xian)(xian)纖(xian)維腺(xian)(xian)(xian)瘤,應借助影像(xiang)學檢查(cha)鑒別診(zhen)斷,必要時需依據病(bing)理(li)組織學檢查(cha)確診(zhen)。
1.密切(qie)觀察、定期(qi)隨診
乳腺(xian)(xian)纖維腺(xian)(xian)瘤(liu)是常(chang)見的良性腫(zhong)瘤(liu),極少惡(e)變。發展(zhan)緩慢,沒有癥狀,不影響生活和(he)工作,可(ke)以密切觀察定(ding)期隨診。
2.外(wai)科手術切除
(1)觀察過程(cheng)中(zhong),如(ru)乳房(fang)自查或(huo)去(qu)醫(yi)院檢查,發現(xian)纖(xian)維腺瘤有增大(da)(da)傾(qing)向,或(huo)彩超原(yuan)顯(xian)示腫塊(kuai)內無血(xue)流(liu)信號現(xian)可見大(da)(da)量(liang)血(xue)流(liu)信號,應手術切除。
(2)乳(ru)(ru)腺(xian)(xian)纖維(wei)(wei)瘤(liu)患者(zhe),準備懷(huai)孕之前,應進(jin)(jin)行(xing)纖維(wei)(wei)腺(xian)(xian)瘤(liu)切(qie)除術。原因:a.乳(ru)(ru)腺(xian)(xian)纖維(wei)(wei)腺(xian)(xian)瘤(liu)的發生(sheng)與雌激(ji)素水平升高有(you)關,妊娠、哺(bu)乳(ru)(ru)期,隨著體內激(ji)素水平的變(bian)化,可(ke)導致腫瘤(liu)體積迅速增(zeng)大。b.妊娠期乳(ru)(ru)腺(xian)(xian)不(bu)宜進(jin)(jin)行(xing)手術及有(you)創性(xing)檢查(cha),哺(bu)乳(ru)(ru)期亦不(bu)適(shi)合手術。
(3)青(qing)少年巨大纖維腺瘤(liu)(liu)(幼年性(xing)纖維腺瘤(liu)(liu)),因腫瘤(liu)(liu)生長快,體積大,對(dui)正常乳(ru)腺組織產生擠壓,應考(kao)慮手術(shu)切(qie)除,手術(shu)不會對(dui)以后(hou)的妊(ren)娠(shen)、哺乳(ru)產生不良(liang)影響(xiang)。
(4)有乳腺癌家族史者可(ke)考慮手術切(qie)除。
3.乳(ru)腺微創旋切手(shou)術
選擇(ze)乳(ru)腺(xian)纖(xian)維腺(xian)瘤診(zhen)斷明確者(不(bu)適宜乳(ru)腺(xian)癌的治療)。利用真空輔助(zhu)旋(xuan)切設備,在(zai)乳(ru)腺(xian)超聲(sheng)引導下,一次進針多次切割將腫瘤切除。切口僅0.3cm,恢復(fu)快,美學(xue)效(xiao)果好。纖(xian)維腺(xian)瘤完(wan)整切除后(hou)很少復(fu)發(fa),但(dan)可再發(fa)。
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