广州医科大学学报

目的:探讨盆腔脂肪增多症的临床特征及治疗手段。方法:本院泌尿外科收治盆腔脂肪增多症1例,男,50岁。影像学主要表现为:IVU示双肾中度积水,典型倒梨形膀胱、后尿道延长;CT示双肾功能减退,双肾积液,左肾萎缩,盆腔内均匀低密度脂肪堆积。采用剖腹探查清除盆腔及输尿管周围脂肪组织、松解输尿管下段方法治疗。结合文献复习讨论盆腔脂肪增多症诊治特点。结果:术中可见盆腔脏器脂肪组织明显增多,膀胱、直肠及乙状结肠周围充满大量脂肪组织,与影像学表现一致。手术剔除盆腔及输尿管周围脂肪加输尿管松解术,剔除脂肪组织约200 g,术后病理报告为脂肪组织瘤样增生。术后1周出院。门诊随诊观察。结论:盆腔脂肪增多症临床罕见报道,X线、CT及MRI为此病的主要诊断线索及依据;对肾积水及肾功能受损患者可行定期留置、更换D-J管,盆腔脂肪清除及输尿管粘连松解或输尿管膀胱再植是切实的治疗方法,若症状无改善最终应行尿流改道手术。

Objective:To study the clinical features and treatment of pelvic lipomatosis.Methods:A 50-year -old male with pelvic lipomatosis was admitted.Intravenous urography showed moderate bilateral hydronephrosis,a typical inverted teardrop-shaped bladder and posterior urethra lengthening in this patient.CT scan revealed lowered renal function and hydronephrosis on his both sides,atrophy of the left kidney,and even distribution of low-density adipose tissues in his pelvic cavity.Surgical exploration and removal of the adipose tissue in the pelvic cavity and around the ureters,as well as urethrolysis,were performed.The clinical characteristics of lipomatosis were analyzed with review of literature.Results:At surgery,increased mass of lipid tissue in the pelvic cavity and excessive lipid accumulation surrounding the bladder,rectum and sigmoid colon were noted,which was consistent with the imaging findings.About 200g of fats were removed.Pathologic study indicated tumor-like hyperplasia of adipose tissue.The patient was discharged 1 week after surgery and followed up on a regular basis.Conclusion:Lipomatosis is a rare condition in clinical settings which relies importantly on X-ray,CT scan and MRI for diagnosis.Patients with hydronephrosis or impaired renal function may benefit from regular dwelling and replacement of double-J tube.Removal;of pelvic lipids,adhesiolysis of ureters and ureterocystostomy may be practical solutions.For patients in whom symptoms are not improved,urinary diversion may be needed.