芒果视频下载

乳(ru)腺(xian)(xian)(xian)(xian)(xian)纖(xian)(xian)維(wei)(wei)(wei)(wei)(wei)腺(xian)(xian)(xian)(xian)(xian)瘤(liu)(liu)(liu)(liu)是由(you)腺(xian)(xian)(xian)(xian)(xian)上皮和(he)纖(xian)(xian)維(wei)(wei)(wei)(wei)(wei)組織兩種成(cheng)(cheng)(cheng)(cheng)(cheng)(cheng)分混合組成(cheng)(cheng)(cheng)(cheng)(cheng)(cheng)的(de)(de)良性腫瘤(liu)(liu)(liu)(liu)，好發于青年女性，與患者體(ti)內性激素水平失衡有關。對本病的(de)(de)認(ren)識還有腺(xian)(xian)(xian)(xian)(xian)纖(xian)(xian)維(wei)(wei)(wei)(wei)(wei)瘤(liu)(liu)(liu)(liu)、腺(xian)(xian)(xian)(xian)(xian)瘤(liu)(liu)(liu)(liu)之稱(cheng)(cheng)，是由(you)于構成(cheng)(cheng)(cheng)(cheng)(cheng)(cheng)腫瘤(liu)(liu)(liu)(liu)的(de)(de)纖(xian)(xian)維(wei)(wei)(wei)(wei)(wei)成(cheng)(cheng)(cheng)(cheng)(cheng)(cheng)分和(he)腺(xian)(xian)(xian)(xian)(xian)上皮增(zeng)生(sheng)程度的(de)(de)不(bu)同(tong)所致。當腫瘤(liu)(liu)(liu)(liu)構成(cheng)(cheng)(cheng)(cheng)(cheng)(cheng)以腺(xian)(xian)(xian)(xian)(xian)上皮增(zeng)生(sheng)為主(zhu)，而纖(xian)(xian)維(wei)(wei)(wei)(wei)(wei)成(cheng)(cheng)(cheng)(cheng)(cheng)(cheng)分較少時稱(cheng)(cheng)為纖(xian)(xian)維(wei)(wei)(wei)(wei)(wei)腺(xian)(xian)(xian)(xian)(xian)瘤(liu)(liu)(liu)(liu)；若(ruo)纖(xian)(xian)維(wei)(wei)(wei)(wei)(wei)組織在腫瘤(liu)(liu)(liu)(liu)中占多數(shu)，腺(xian)(xian)(xian)(xian)(xian)管成(cheng)(cheng)(cheng)(cheng)(cheng)(cheng)分較少時，稱(cheng)(cheng)為腺(xian)(xian)(xian)(xian)(xian)纖(xian)(xian)維(wei)(wei)(wei)(wei)(wei)瘤(liu)(liu)(liu)(liu)；腫瘤(liu)(liu)(liu)(liu)組織由(you)大量腺(xian)(xian)(xian)(xian)(xian)管成(cheng)(cheng)(cheng)(cheng)(cheng)(cheng)分組成(cheng)(cheng)(cheng)(cheng)(cheng)(cheng)時，則(ze)稱(cheng)(cheng)為腺(xian)(xian)(xian)(xian)(xian)瘤(liu)(liu)(liu)(liu)。上述三種分類只是病理形態學方面的(de)(de)差異，其臨床(chuang)表(biao)現、治療及預(yu)后并無不(bu)同(tong)，故統稱(cheng)(cheng)為纖(xian)(xian)維(wei)(wei)(wei)(wei)(wei)腺(xian)(xian)(xian)(xian)(xian)瘤(liu)(liu)(liu)(liu)。乳(ru)腺(xian)(xian)(xian)(xian)(xian)纖(xian)(xian)維(wei)(wei)(wei)(wei)(wei)腺(xian)(xian)(xian)(xian)(xian)瘤(liu)(liu)(liu)(liu)好發于乳(ru)房外上象限，呈圓形或卵圓形，臨床(chuang)多見1～3cm，生(sheng)長緩慢，妊娠或哺乳(ru)期(qi)時可急驟增(zeng)長。極少數(shu)青春期(qi)發生(sheng)的(de)(de)纖(xian)(xian)維(wei)(wei)(wei)(wei)(wei)腺(xian)(xian)(xian)(xian)(xian)瘤(liu)(liu)(liu)(liu)可在短時間內迅(xun)速增(zeng)大，直徑可達8～10cm，稱(cheng)(cheng)為巨大纖(xian)(xian)維(wei)(wei)(wei)(wei)(wei)腺(xian)(xian)(xian)(xian)(xian)瘤(liu)(liu)(liu)(liu)，仍屬(shu)良性腫瘤(liu)(liu)(liu)(liu)。纖(xian)(xian)維(wei)(wei)(wei)(wei)(wei)腺(xian)(xian)(xian)(xian)(xian)瘤(liu)(liu)(liu)(liu)惡變成(cheng)(cheng)(cheng)(cheng)(cheng)(cheng)纖(xian)(xian)維(wei)(wei)(wei)(wei)(wei)肉瘤(liu)(liu)(liu)(liu)或乳(ru)腺(xian)(xian)(xian)(xian)(xian)癌者極少見，不(bu)到(dao)1%。

病因

卵巢(chao)功能旺(wang)盛，雌激(ji)素(su)(su)水平過高，調(diao)節(jie)失(shi)衡，加之患(huan)者對雌激(ji)素(su)(su)反應敏感(gan)，在雌激(ji)素(su)(su)的長(chang)期刺激(ji)下，引起乳腺(xian)腺(xian)上皮組織和纖維(wei)組織過度增生，結構紊亂(luan)，形(xing)成腫瘤。由于乳腺(xian)纖維(wei)腺(xian)瘤與性(xing)激(ji)素(su)(su)分泌旺(wang)盛有關(guan)，故此多發(fa)生在青年女性(xing)，月經來潮(chao)前或絕經后婦女少見。

臨床表現

主要為乳房(fang)無(wu)(wu)痛(tong)性腫塊，很(hen)少伴(ban)有(you)乳房(fang)疼痛(tong)或(huo)乳頭溢液。腫塊往(wang)往(wang)是無(wu)(wu)意中、洗(xi)澡時，或(huo)體檢中被發現。單發腫塊居多，亦可(ke)多發，也可(ke)兩(liang)側乳房(fang)同時或(huo)先后觸(chu)及腫塊。多為圓形(xing)或(huo)橢圓形(xing)，直徑常為1～3cm，亦有(you)更小或(huo)更大(da)者，偶(ou)可(ke)見巨大(da)者。境界清楚(chu)，邊緣整齊，表面光滑，富有(you)彈性，無(wu)(wu)壓痛(tong)，活(huo)動度較大(da)，與皮膚無(wu)(wu)粘連。

檢查

1.彩超

能顯示乳房(fang)各層次結構(gou)及腫(zhong)塊形態、大小及回(hui)(hui)聲(sheng)(sheng)(sheng)狀(zhuang)況。乳腺(xian)纖維(wei)腺(xian)瘤(liu)彩超多(duo)為(wei)圓(yuan)形、卵圓(yuan)形均(jun)勻低回(hui)(hui)聲(sheng)(sheng)(sheng)腫(zhong)物，多(duo)可見(jian)光滑清晰的(de)包膜回(hui)(hui)聲(sheng)(sheng)(sheng)，腫(zhong)塊后(hou)方(fang)回(hui)(hui)聲(sheng)(sheng)(sheng)正常或輕微增強，可見(jian)側方(fang)聲(sheng)(sheng)(sheng)影，腫(zhong)塊內(nei)可見(jian)伴聲(sheng)(sheng)(sheng)影的(de)粗大鈣化。彩色多(duo)普勒(le)顯示腫(zhong)塊內(nei)多(duo)無血流信號(hao)或見(jian)少(shao)量血流信號(hao)，RI<0.7。

2.乳(ru)腺X線(xian)攝影

青春(chun)期(qi)女孩，致密(mi)(mi)型乳(ru)腺(xian)，不(bu)適宜進(jin)行乳(ru)腺(xian)X線攝影。中年及以上婦女乳(ru)腺(xian)X線片(pian)纖維腺(xian)瘤表(biao)現(xian)為(wei)圓形、卵圓形腫塊(kuai)(kuai)(kuai)(kuai)，也可呈分(fen)葉狀(zhuang)，直徑多(duo)為(wei)1～3cm，邊緣(yuan)光滑清(qing)楚(chu)，與等體積的正常腺(xian)體比較(jiao)，腫塊(kuai)(kuai)(kuai)(kuai)呈等或(huo)稍高密(mi)(mi)度(du)，周(zhou)圍可有低密(mi)(mi)度(du)暈環。部分(fen)病灶內可見鈣(gai)化(hua)，鈣(gai)化(hua)多(duo)位(wei)于腫塊(kuai)(kuai)(kuai)(kuai)中心或(huo)邊緣(yuan)，多(duo)呈粗(cu)顆粒(li)(li)狀(zhuang)、樹枝(zhi)狀(zhuang)或(huo)斑點(dian)狀(zhuang)，也可相互融合(he)成(cheng)大塊(kuai)(kuai)(kuai)(kuai)狀(zhuang)，占據腫塊(kuai)(kuai)(kuai)(kuai)大部或(huo)全部，與乳(ru)腺(xian)癌(ai)的成(cheng)簇沙粒(li)(li)樣鈣(gai)化(hua)灶不(bu)同。

3.乳腺病灶(zao)活檢

根據病史、體(ti)檢(jian)(jian)(jian)或(huo)影像(xiang)學檢(jian)(jian)(jian)查難以鑒(jian)別的(de)乳腺腫塊(kuai)，可采(cai)取(qu)穿刺(ci)或(huo)手術切(qie)除的(de)方(fang)法，進(jin)行(xing)組織病理(li)學檢(jian)(jian)(jian)查，明確診斷。

診斷

乳房(fang)位于體(ti)表，典型的(de)乳腺(xian)(xian)纖維(wei)腺(xian)(xian)瘤(liu)相對容易診斷。青少(shao)年女(nv)性，無(wu)意中(zhong)或(huo)體(ti)檢(jian)(jian)中(zhong)發(fa)現乳房(fang)無(wu)痛(tong)性腫(zhong)塊(kuai)1～3cm，圓形或(huo)卵圓形，與(yu)(yu)周(zhou)圍(wei)無(wu)粘(zhan)連(lian)，活動度(du)大，觸診有滑脫感；生長緩慢(man)，與(yu)(yu)月經周(zhou)期(qi)無(wu)關(guan)；臨(lin)床可考慮為乳腺(xian)(xian)纖維(wei)腺(xian)(xian)瘤(liu)。但對于妊娠后，特別(bie)是絕經后婦(fu)女(nv)，乳房(fang)發(fa)現無(wu)痛(tong)性腫(zhong)塊(kuai)，要提高(gao)警惕，不要輕易診斷乳腺(xian)(xian)纖維(wei)腺(xian)(xian)瘤(liu)，應借助影像學檢(jian)(jian)查鑒別(bie)診斷，必要時需依據(ju)病理組織學檢(jian)(jian)查確診。

治療

1.密切(qie)觀察、定期(qi)隨診

乳腺纖維腺瘤(liu)是(shi)常見的(de)良(liang)性腫瘤(liu)，極少(shao)惡變。發展緩慢，沒有癥狀，不影(ying)響(xiang)生活和工作，可以密切觀察定(ding)期隨診。

2.外科手術切除

（1）觀察過程中，如(ru)乳房自查或去醫(yi)院檢查，發現(xian)纖維腺瘤有增大(da)傾向(xiang)，或彩超(chao)原顯示腫塊(kuai)內無血(xue)流信號(hao)現(xian)可見大(da)量(liang)血(xue)流信號(hao)，應手術(shu)切除。

（2）乳(ru)腺(xian)纖(xian)維瘤(liu)患(huan)者，準備懷孕之前，應進行(xing)纖(xian)維腺(xian)瘤(liu)切除術(shu)。原因(yin)：a.乳(ru)腺(xian)纖(xian)維腺(xian)瘤(liu)的(de)發生與雌激素水平升高有關(guan)，妊娠、哺(bu)乳(ru)期，隨(sui)著體內(nei)激素水平的(de)變化，可導致腫瘤(liu)體積迅速(su)增(zeng)大(da)。b.妊娠期乳(ru)腺(xian)不宜進行(xing)手(shou)術(shu)及有創(chuang)性檢查，哺(bu)乳(ru)期亦不適合手(shou)術(shu)。

（3）青少年巨大(da)纖維腺瘤（幼年性纖維腺瘤），因腫瘤生長(chang)快，體積大(da)，對正常乳腺組織(zhi)產(chan)生擠壓，應考慮手(shou)術切除(chu)，手(shou)術不(bu)會對以后的妊娠(shen)、哺乳產(chan)生不(bu)良影響。

（4）有乳腺(xian)癌家族史者可考慮(lv)手術切除。

3.乳腺微(wei)創(chuang)旋切手(shou)術

選擇乳(ru)腺(xian)(xian)(xian)纖(xian)維(wei)腺(xian)(xian)(xian)瘤診(zhen)斷(duan)明確者（不適宜(yi)乳(ru)腺(xian)(xian)(xian)癌的(de)治(zhi)療）。利用真空輔助旋切(qie)設(she)備，在乳(ru)腺(xian)(xian)(xian)超聲引(yin)導下(xia)，一次(ci)進(jin)針多次(ci)切(qie)割將(jiang)腫瘤切(qie)除。切(qie)口僅0.3cm，恢復快(kuai)，美學效(xiao)果好。纖(xian)維(wei)腺(xian)(xian)(xian)瘤完整切(qie)除后很少復發，但可再發。

預防

建立良好地生活飲(yin)食習(xi)慣(guan)，避免和減少心理緊張(zhang)因素，保持心情舒暢。控制高脂(zhi)肪、高熱量飲(yin)食的(de)攝入，不(bu)亂服用外源(yuan)性雌激(ji)素。掌握(wo)乳房(fang)自我檢查方法，養成(cheng)每(mei)月一次(ci)的(de)乳房(fang)自查習(xi)慣(guan)，若(ruo)發現原因不(bu)明(ming)的(de)乳腺結節(jie)，應(ying)及時去(qu)醫院診(zhen)斷。積(ji)極參加乳腺癌篩查。