乳(ru)(ru)腺(xian)(xian)(xian)纖(xian)維(wei)(wei)(wei)(wei)腺(xian)(xian)(xian)瘤(liu)(liu)(liu)是(shi)由(you)腺(xian)(xian)(xian)上(shang)(shang)皮(pi)和纖(xian)維(wei)(wei)(wei)(wei)組織兩種成(cheng)(cheng)分(fen)混合組成(cheng)(cheng)的(de)良(liang)性(xing)腫瘤(liu)(liu)(liu),好(hao)發(fa)于青(qing)年女性(xing),與(yu)患者體內性(xing)激素水(shui)平失衡有(you)關。對本病(bing)的(de)認識還有(you)腺(xian)(xian)(xian)纖(xian)維(wei)(wei)(wei)(wei)瘤(liu)(liu)(liu)、腺(xian)(xian)(xian)瘤(liu)(liu)(liu)之稱(cheng),是(shi)由(you)于構(gou)成(cheng)(cheng)腫瘤(liu)(liu)(liu)的(de)纖(xian)維(wei)(wei)(wei)(wei)成(cheng)(cheng)分(fen)和腺(xian)(xian)(xian)上(shang)(shang)皮(pi)增(zeng)生(sheng)程(cheng)度的(de)不(bu)(bu)(bu)同(tong)所致。當腫瘤(liu)(liu)(liu)構(gou)成(cheng)(cheng)以腺(xian)(xian)(xian)上(shang)(shang)皮(pi)增(zeng)生(sheng)為(wei)(wei)主,而(er)纖(xian)維(wei)(wei)(wei)(wei)成(cheng)(cheng)分(fen)較(jiao)少(shao)(shao)時(shi)稱(cheng)為(wei)(wei)纖(xian)維(wei)(wei)(wei)(wei)腺(xian)(xian)(xian)瘤(liu)(liu)(liu);若纖(xian)維(wei)(wei)(wei)(wei)組織在腫瘤(liu)(liu)(liu)中占多數,腺(xian)(xian)(xian)管成(cheng)(cheng)分(fen)較(jiao)少(shao)(shao)時(shi),稱(cheng)為(wei)(wei)腺(xian)(xian)(xian)纖(xian)維(wei)(wei)(wei)(wei)瘤(liu)(liu)(liu);腫瘤(liu)(liu)(liu)組織由(you)大(da)量腺(xian)(xian)(xian)管成(cheng)(cheng)分(fen)組成(cheng)(cheng)時(shi),則稱(cheng)為(wei)(wei)腺(xian)(xian)(xian)瘤(liu)(liu)(liu)。上(shang)(shang)述三種分(fen)類只(zhi)是(shi)病(bing)理(li)形(xing)態學方面的(de)差異,其臨(lin)床(chuang)表現、治療及預(yu)后(hou)并無不(bu)(bu)(bu)同(tong),故統稱(cheng)為(wei)(wei)纖(xian)維(wei)(wei)(wei)(wei)腺(xian)(xian)(xian)瘤(liu)(liu)(liu)。乳(ru)(ru)腺(xian)(xian)(xian)纖(xian)維(wei)(wei)(wei)(wei)腺(xian)(xian)(xian)瘤(liu)(liu)(liu)好(hao)發(fa)于乳(ru)(ru)房(fang)外(wai)上(shang)(shang)象限,呈(cheng)圓(yuan)形(xing)或(huo)卵圓(yuan)形(xing),臨(lin)床(chuang)多見1~3cm,生(sheng)長(chang)緩慢,妊娠(shen)或(huo)哺乳(ru)(ru)期時(shi)可(ke)急驟增(zeng)長(chang)。極少(shao)(shao)數青(qing)春期發(fa)生(sheng)的(de)纖(xian)維(wei)(wei)(wei)(wei)腺(xian)(xian)(xian)瘤(liu)(liu)(liu)可(ke)在短時(shi)間內迅速增(zeng)大(da),直徑可(ke)達8~10cm,稱(cheng)為(wei)(wei)巨大(da)纖(xian)維(wei)(wei)(wei)(wei)腺(xian)(xian)(xian)瘤(liu)(liu)(liu),仍屬良(liang)性(xing)腫瘤(liu)(liu)(liu)。纖(xian)維(wei)(wei)(wei)(wei)腺(xian)(xian)(xian)瘤(liu)(liu)(liu)惡變成(cheng)(cheng)纖(xian)維(wei)(wei)(wei)(wei)肉瘤(liu)(liu)(liu)或(huo)乳(ru)(ru)腺(xian)(xian)(xian)癌者極少(shao)(shao)見,不(bu)(bu)(bu)到1%。
卵(luan)巢功能旺盛,雌(ci)激素(su)(su)水平過高,調節(jie)失衡,加(jia)之患者(zhe)對雌(ci)激素(su)(su)反應(ying)敏感,在(zai)雌(ci)激素(su)(su)的長期刺激下,引起乳(ru)腺(xian)腺(xian)上皮組織和(he)纖維(wei)(wei)組織過度增(zeng)生,結構紊亂,形成腫瘤。由于(yu)乳(ru)腺(xian)纖維(wei)(wei)腺(xian)瘤與性激素(su)(su)分泌(mi)旺盛有(you)關,故此(ci)多發生在(zai)青年女性,月經來潮前或絕經后(hou)婦女少見。
主要為乳房無痛(tong)性腫塊,很少伴有乳房疼痛(tong)或(huo)乳頭溢(yi)液。腫塊往往是無意中、洗澡(zao)時,或(huo)體檢中被發現(xian)。單(dan)發腫塊居多,亦(yi)可(ke)(ke)多發,也可(ke)(ke)兩(liang)側乳房同時或(huo)先(xian)后觸及(ji)腫塊。多為圓(yuan)(yuan)形或(huo)橢圓(yuan)(yuan)形,直徑常為1~3cm,亦(yi)有更(geng)小或(huo)更(geng)大(da)者,偶可(ke)(ke)見巨大(da)者。境界清楚,邊(bian)緣整齊,表面光(guang)滑,富有彈性,無壓(ya)痛(tong),活動度較大(da),與皮膚無粘連。
1.彩超
能顯(xian)示乳房(fang)各層次結構及腫(zhong)(zhong)塊(kuai)形(xing)態、大小及回(hui)(hui)聲狀況。乳腺纖維腺瘤彩(cai)超(chao)多(duo)為(wei)圓形(xing)、卵圓形(xing)均勻低回(hui)(hui)聲腫(zhong)(zhong)物,多(duo)可(ke)見光滑清晰的包膜回(hui)(hui)聲,腫(zhong)(zhong)塊(kuai)后方回(hui)(hui)聲正常或(huo)輕微(wei)增強,可(ke)見側方聲影(ying),腫(zhong)(zhong)塊(kuai)內(nei)可(ke)見伴聲影(ying)的粗大鈣(gai)化。彩(cai)色(se)多(duo)普勒顯(xian)示腫(zhong)(zhong)塊(kuai)內(nei)多(duo)無(wu)血流信號或(huo)見少量血流信號,RI<0.7。
2.乳腺X線(xian)攝(she)影
青春期(qi)女(nv)孩,致密(mi)型乳腺,不適宜進行乳腺X線(xian)攝影。中(zhong)年及以上婦(fu)女(nv)乳腺X線(xian)片纖(xian)維腺瘤表(biao)現為圓形、卵圓形腫塊(kuai),也可(ke)呈(cheng)(cheng)分葉狀(zhuang),直徑多為1~3cm,邊(bian)(bian)緣光滑清楚,與(yu)等(deng)體(ti)積的正常(chang)腺體(ti)比較,腫塊(kuai)呈(cheng)(cheng)等(deng)或稍高密(mi)度(du),周圍(wei)可(ke)有低密(mi)度(du)暈環。部(bu)(bu)分病灶內可(ke)見鈣化,鈣化多位于腫塊(kuai)中(zhong)心或邊(bian)(bian)緣,多呈(cheng)(cheng)粗顆粒狀(zhuang)、樹枝(zhi)狀(zhuang)或斑點(dian)狀(zhuang),也可(ke)相互(hu)融合成大塊(kuai)狀(zhuang),占據腫塊(kuai)大部(bu)(bu)或全部(bu)(bu),與(yu)乳腺癌的成簇(cu)沙(sha)粒樣鈣化灶不同。
3.乳(ru)腺(xian)病灶活檢
根據病史、體檢(jian)或(huo)影像學(xue)檢(jian)查難以(yi)鑒別(bie)的乳腺(xian)腫塊,可(ke)采取(qu)穿刺或(huo)手術切除(chu)的方法,進行組織病理學(xue)檢(jian)查,明確診斷(duan)。
乳(ru)(ru)(ru)房位(wei)于體(ti)表,典(dian)型的乳(ru)(ru)(ru)腺(xian)(xian)纖維(wei)(wei)腺(xian)(xian)瘤相對容易(yi)診(zhen)斷(duan)(duan)。青少年女性(xing)(xing),無(wu)意中(zhong)或體(ti)檢中(zhong)發現乳(ru)(ru)(ru)房無(wu)痛性(xing)(xing)腫塊1~3cm,圓(yuan)形(xing)或卵圓(yuan)形(xing),與(yu)周(zhou)圍無(wu)粘連,活(huo)動(dong)度大,觸(chu)診(zhen)有滑脫感(gan);生(sheng)長緩慢,與(yu)月經周(zhou)期無(wu)關;臨(lin)床可考慮為乳(ru)(ru)(ru)腺(xian)(xian)纖維(wei)(wei)腺(xian)(xian)瘤。但對于妊娠(shen)后,特別是絕經后婦(fu)女,乳(ru)(ru)(ru)房發現無(wu)痛性(xing)(xing)腫塊,要提高警惕(ti),不要輕易(yi)診(zhen)斷(duan)(duan)乳(ru)(ru)(ru)腺(xian)(xian)纖維(wei)(wei)腺(xian)(xian)瘤,應(ying)借助影像學(xue)(xue)檢查鑒(jian)別診(zhen)斷(duan)(duan),必要時需(xu)依據病理組織學(xue)(xue)檢查確診(zhen)。
1.密切(qie)觀察(cha)、定期隨診
乳腺纖維(wei)腺瘤是常見的良性腫瘤,極少(shao)惡(e)變(bian)。發展緩慢,沒有癥狀,不影響生活(huo)和工作,可以密切觀察(cha)定期隨診(zhen)。
2.外科手(shou)術(shu)切除
(1)觀(guan)察過程中,如(ru)乳房自查(cha)或去醫院檢查(cha),發現纖維腺瘤有增大(da)傾向(xiang),或彩超原顯示腫塊內無血流信號(hao)現可(ke)見大(da)量(liang)血流信號(hao),應手術切(qie)除。
(2)乳腺(xian)纖維瘤患者,準備懷孕之前,應進行纖維腺(xian)瘤切除術。原因:a.乳腺(xian)纖維腺(xian)瘤的發生(sheng)與雌激(ji)素水平升高有關,妊娠、哺乳期(qi),隨著體內激(ji)素水平的變化,可導致腫瘤體積(ji)迅速增大。b.妊娠期(qi)乳腺(xian)不宜進行手術及有創性(xing)檢(jian)查(cha),哺乳期(qi)亦不適合手術。
(3)青(qing)少(shao)年(nian)巨大(da)纖維(wei)腺(xian)瘤(liu)(幼年(nian)性纖維(wei)腺(xian)瘤(liu)),因腫(zhong)瘤(liu)生長快,體積大(da),對(dui)正(zheng)常乳(ru)腺(xian)組織產(chan)生擠壓,應考(kao)慮手(shou)術切除,手(shou)術不會對(dui)以后的妊娠、哺乳(ru)產(chan)生不良(liang)影響。
(4)有乳腺癌家族史(shi)者可考(kao)慮手術切除(chu)。
3.乳腺微(wei)創旋切(qie)手術
選擇(ze)乳腺纖維腺瘤(liu)診斷(duan)明(ming)確者(zhe)(不適宜(yi)乳腺癌(ai)的治(zhi)療(liao))。利用真空輔(fu)助旋切(qie)設備,在(zai)乳腺超聲引導下,一次(ci)(ci)進針多次(ci)(ci)切(qie)割將腫瘤(liu)切(qie)除(chu)。切(qie)口僅0.3cm,恢復(fu)快(kuai),美學效果好。纖維腺瘤(liu)完(wan)整切(qie)除(chu)后很少復(fu)發,但(dan)可再發。
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