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乳(ru)(ru)腺(xian)(xian)(xian)(xian)纖(xian)(xian)(xian)(xian)維(wei)(wei)(wei)(wei)腺(xian)(xian)(xian)(xian)瘤(liu)(liu)是(shi)由腺(xian)(xian)(xian)(xian)上(shang)(shang)皮(pi)和(he)(he)纖(xian)(xian)(xian)(xian)維(wei)(wei)(wei)(wei)組織(zhi)兩種(zhong)成(cheng)(cheng)(cheng)分(fen)混(hun)合組成(cheng)(cheng)(cheng)的良性腫(zhong)(zhong)瘤(liu)(liu)，好發于(yu)青年(nian)女性，與患者體內性激素水平失衡有關。對本(ben)病的認識還有腺(xian)(xian)(xian)(xian)纖(xian)(xian)(xian)(xian)維(wei)(wei)(wei)(wei)瘤(liu)(liu)、腺(xian)(xian)(xian)(xian)瘤(liu)(liu)之稱(cheng)(cheng)，是(shi)由于(yu)構成(cheng)(cheng)(cheng)腫(zhong)(zhong)瘤(liu)(liu)的纖(xian)(xian)(xian)(xian)維(wei)(wei)(wei)(wei)成(cheng)(cheng)(cheng)分(fen)和(he)(he)腺(xian)(xian)(xian)(xian)上(shang)(shang)皮(pi)增生(sheng)(sheng)程度的不同(tong)所致(zhi)。當腫(zhong)(zhong)瘤(liu)(liu)構成(cheng)(cheng)(cheng)以腺(xian)(xian)(xian)(xian)上(shang)(shang)皮(pi)增生(sheng)(sheng)為(wei)(wei)(wei)主，而纖(xian)(xian)(xian)(xian)維(wei)(wei)(wei)(wei)成(cheng)(cheng)(cheng)分(fen)較少時稱(cheng)(cheng)為(wei)(wei)(wei)纖(xian)(xian)(xian)(xian)維(wei)(wei)(wei)(wei)腺(xian)(xian)(xian)(xian)瘤(liu)(liu)；若(ruo)纖(xian)(xian)(xian)(xian)維(wei)(wei)(wei)(wei)組織(zhi)在(zai)腫(zhong)(zhong)瘤(liu)(liu)中占(zhan)多(duo)數(shu)，腺(xian)(xian)(xian)(xian)管成(cheng)(cheng)(cheng)分(fen)較少時，稱(cheng)(cheng)為(wei)(wei)(wei)腺(xian)(xian)(xian)(xian)纖(xian)(xian)(xian)(xian)維(wei)(wei)(wei)(wei)瘤(liu)(liu)；腫(zhong)(zhong)瘤(liu)(liu)組織(zhi)由大(da)量腺(xian)(xian)(xian)(xian)管成(cheng)(cheng)(cheng)分(fen)組成(cheng)(cheng)(cheng)時，則稱(cheng)(cheng)為(wei)(wei)(wei)腺(xian)(xian)(xian)(xian)瘤(liu)(liu)。上(shang)(shang)述三種(zhong)分(fen)類只是(shi)病理形(xing)態學方面的差異，其臨(lin)床表現、治療(liao)及(ji)預后并(bing)無不同(tong)，故統(tong)稱(cheng)(cheng)為(wei)(wei)(wei)纖(xian)(xian)(xian)(xian)維(wei)(wei)(wei)(wei)腺(xian)(xian)(xian)(xian)瘤(liu)(liu)。乳(ru)(ru)腺(xian)(xian)(xian)(xian)纖(xian)(xian)(xian)(xian)維(wei)(wei)(wei)(wei)腺(xian)(xian)(xian)(xian)瘤(liu)(liu)好發于(yu)乳(ru)(ru)房(fang)外上(shang)(shang)象限(xian)，呈圓形(xing)或卵圓形(xing)，臨(lin)床多(duo)見(jian)1～3cm，生(sheng)(sheng)長(chang)緩慢，妊娠或哺乳(ru)(ru)期時可急驟增長(chang)。極(ji)少數(shu)青春(chun)期發生(sheng)(sheng)的纖(xian)(xian)(xian)(xian)維(wei)(wei)(wei)(wei)腺(xian)(xian)(xian)(xian)瘤(liu)(liu)可在(zai)短時間內迅速(su)增大(da)，直徑(jing)可達8～10cm，稱(cheng)(cheng)為(wei)(wei)(wei)巨大(da)纖(xian)(xian)(xian)(xian)維(wei)(wei)(wei)(wei)腺(xian)(xian)(xian)(xian)瘤(liu)(liu)，仍屬良性腫(zhong)(zhong)瘤(liu)(liu)。纖(xian)(xian)(xian)(xian)維(wei)(wei)(wei)(wei)腺(xian)(xian)(xian)(xian)瘤(liu)(liu)惡變成(cheng)(cheng)(cheng)纖(xian)(xian)(xian)(xian)維(wei)(wei)(wei)(wei)肉瘤(liu)(liu)或乳(ru)(ru)腺(xian)(xian)(xian)(xian)癌(ai)者極(ji)少見(jian)，不到1%。

病因

卵巢功能(neng)旺盛(sheng)，雌激(ji)素(su)水平過高，調節(jie)失衡，加之患者對雌激(ji)素(su)反應敏感，在雌激(ji)素(su)的(de)長期刺激(ji)下，引起乳腺(xian)腺(xian)上皮(pi)組(zu)織和(he)纖維組(zu)織過度增(zeng)生，結(jie)構紊亂，形成腫瘤(liu)。由于乳腺(xian)纖維腺(xian)瘤(liu)與性(xing)激(ji)素(su)分泌(mi)旺盛(sheng)有關，故此多發(fa)生在青年女性(xing)，月(yue)經來(lai)潮前或絕經后婦(fu)女少見(jian)。

臨床表現

主要為(wei)乳房無痛(tong)性腫(zhong)(zhong)塊(kuai)(kuai)(kuai)，很少伴有(you)乳房疼痛(tong)或(huo)乳頭溢液。腫(zhong)(zhong)塊(kuai)(kuai)(kuai)往往是無意中、洗澡時，或(huo)體檢(jian)中被發現。單(dan)發腫(zhong)(zhong)塊(kuai)(kuai)(kuai)居多(duo)(duo)，亦可(ke)多(duo)(duo)發，也可(ke)兩側乳房同時或(huo)先后觸及腫(zhong)(zhong)塊(kuai)(kuai)(kuai)。多(duo)(duo)為(wei)圓(yuan)形或(huo)橢圓(yuan)形，直徑常(chang)為(wei)1～3cm，亦有(you)更小或(huo)更大者，偶可(ke)見巨(ju)大者。境界清楚(chu)，邊緣(yuan)整(zheng)齊，表面(mian)光滑，富有(you)彈性，無壓痛(tong)，活動度較大，與皮膚無粘連(lian)。

檢查

1.彩超

能顯示乳房各層(ceng)次結構及腫(zhong)塊(kuai)形(xing)態(tai)、大小及回聲(sheng)(sheng)狀況。乳腺纖維腺瘤彩(cai)超多(duo)為圓形(xing)、卵圓形(xing)均勻低回聲(sheng)(sheng)腫(zhong)物，多(duo)可見(jian)光滑清晰的(de)包膜回聲(sheng)(sheng)，腫(zhong)塊(kuai)后方(fang)回聲(sheng)(sheng)正常或輕(qing)微(wei)增強，可見(jian)側(ce)方(fang)聲(sheng)(sheng)影，腫(zhong)塊(kuai)內可見(jian)伴聲(sheng)(sheng)影的(de)粗(cu)大鈣化(hua)。彩(cai)色(se)多(duo)普勒顯示腫(zhong)塊(kuai)內多(duo)無血(xue)流信(xin)號或見(jian)少量血(xue)流信(xin)號，RI<0.7。

2.乳(ru)腺X線攝影

青春期女孩，致密(mi)型(xing)乳(ru)腺，不適宜進行(xing)乳(ru)腺X線攝影。中年及以上婦(fu)女乳(ru)腺X線片纖(xian)維腺瘤表現為(wei)圓形、卵圓形腫(zhong)(zhong)塊(kuai)(kuai)，也可呈(cheng)分(fen)葉(xie)狀(zhuang)，直徑多為(wei)1～3cm，邊(bian)緣光滑清楚，與等體積(ji)的(de)正常(chang)腺體比較，腫(zhong)(zhong)塊(kuai)(kuai)呈(cheng)等或(huo)稍高密(mi)度，周圍可有低密(mi)度暈環。部分(fen)病灶內可見鈣化(hua)，鈣化(hua)多位于腫(zhong)(zhong)塊(kuai)(kuai)中心或(huo)邊(bian)緣，多呈(cheng)粗顆粒狀(zhuang)、樹(shu)枝狀(zhuang)或(huo)斑點狀(zhuang)，也可相互(hu)融合成(cheng)大塊(kuai)(kuai)狀(zhuang)，占據(ju)腫(zhong)(zhong)塊(kuai)(kuai)大部或(huo)全部，與乳(ru)腺癌(ai)的(de)成(cheng)簇沙粒樣鈣化(hua)灶不同。

3.乳(ru)腺病灶活檢

根據病(bing)史、體(ti)檢(jian)或影像學(xue)檢(jian)查(cha)難以(yi)鑒別的乳腺腫塊，可采取穿刺或手術(shu)切除的方法，進行(xing)組織病(bing)理學(xue)檢(jian)查(cha)，明確診(zhen)斷。

診斷

乳(ru)房位于體(ti)表，典型的乳(ru)腺(xian)(xian)(xian)纖(xian)(xian)維腺(xian)(xian)(xian)瘤(liu)相對容易(yi)診(zhen)斷(duan)。青少年(nian)女性(xing)(xing)，無(wu)意(yi)中或(huo)體(ti)檢中發現乳(ru)房無(wu)痛性(xing)(xing)腫塊(kuai)1～3cm，圓(yuan)形(xing)或(huo)卵圓(yuan)形(xing)，與(yu)周(zhou)圍無(wu)粘連，活動度大，觸診(zhen)有滑脫感；生長緩慢，與(yu)月經周(zhou)期無(wu)關(guan)；臨床可考(kao)慮為乳(ru)腺(xian)(xian)(xian)纖(xian)(xian)維腺(xian)(xian)(xian)瘤(liu)。但對于妊娠后，特(te)別是(shi)絕經后婦(fu)女，乳(ru)房發現無(wu)痛性(xing)(xing)腫塊(kuai)，要(yao)提高警(jing)惕，不要(yao)輕易(yi)診(zhen)斷(duan)乳(ru)腺(xian)(xian)(xian)纖(xian)(xian)維腺(xian)(xian)(xian)瘤(liu)，應(ying)借助(zhu)影(ying)像(xiang)學檢查(cha)鑒(jian)別診(zhen)斷(duan)，必要(yao)時需依據病理(li)組織學檢查(cha)確診(zhen)。

治療

1.密切觀察、定(ding)期隨(sui)診

乳腺纖維腺瘤是(shi)常見的良性腫瘤，極少惡變(bian)。發(fa)展緩慢，沒有癥狀，不(bu)影響生活(huo)和工(gong)作，可以密切(qie)觀察定期隨診(zhen)。

2.外科手(shou)術切(qie)除

（1）觀察過程中，如乳房自查或去醫院檢查，發現纖維(wei)腺瘤有增大傾向，或彩超(chao)原顯示腫塊內(nei)無血流信號現可見大量血流信號，應手術切(qie)除。

（2）乳(ru)腺(xian)纖(xian)維(wei)瘤患者，準備(bei)懷(huai)孕之(zhi)前，應進行纖(xian)維(wei)腺(xian)瘤切除術(shu)。原因：a.乳(ru)腺(xian)纖(xian)維(wei)腺(xian)瘤的發生與雌激素水平升(sheng)高有(you)關，妊(ren)(ren)娠(shen)、哺乳(ru)期，隨著體內激素水平的變化，可導致腫瘤體積迅速增大。b.妊(ren)(ren)娠(shen)期乳(ru)腺(xian)不(bu)宜進行手術(shu)及有(you)創性檢(jian)查，哺乳(ru)期亦(yi)不(bu)適合手術(shu)。

（3）青少年巨大纖維腺瘤（幼年性(xing)纖維腺瘤），因腫瘤生(sheng)(sheng)(sheng)長快，體積大，對(dui)正(zheng)常(chang)乳腺組織產生(sheng)(sheng)(sheng)擠壓(ya)，應考慮手(shou)術(shu)切除，手(shou)術(shu)不會對(dui)以(yi)后的妊娠、哺乳產生(sheng)(sheng)(sheng)不良影響。

（4）有(you)乳腺(xian)癌家族史者(zhe)可考慮手術切除。

3.乳腺微創旋切手(shou)術(shu)

選擇乳腺(xian)纖維腺(xian)瘤診斷明確(que)者（不適宜(yi)乳腺(xian)癌的治療(liao)）。利(li)用真空輔助旋切設(she)備，在(zai)乳腺(xian)超聲引導下(xia)，一次進針多次切割將腫瘤切除。切口僅0.3cm，恢復(fu)(fu)快，美學(xue)效果好(hao)。纖維腺(xian)瘤完整(zheng)切除后很(hen)少復(fu)(fu)發，但(dan)可再發。

預防

建立(li)良(liang)好地生活飲食習慣，避免和(he)減少心(xin)理緊張(zhang)因素(su)，保持(chi)心(xin)情舒暢(chang)。控制(zhi)高(gao)(gao)脂肪、高(gao)(gao)熱量(liang)飲食的(de)攝入，不亂服用(yong)外源(yuan)性(xing)雌激素(su)。掌握乳房(fang)(fang)自我檢查(cha)方法(fa)，養成每月(yue)一次的(de)乳房(fang)(fang)自查(cha)習慣，若發(fa)現原因不明的(de)乳腺(xian)結(jie)節，應(ying)及時去醫院診斷(duan)。積極(ji)參加乳腺(xian)癌篩查(cha)。