盆腔脂肪增多症诊治分析

Diagnosis and treatment of pelvic lipomatosis

目的 提高盆腔脂肪增多症的认识。 方法 收治盆腔脂肪增多症 1例 ,男 ,5 1岁。影像学主要表现为 :IVU示双肾轻度积水 ,典型倒梨形膀胱、后尿道延长 ;CT示盆腔内均匀低密度脂肪堆积 ;MRI示膀胱、直肠周围及盆壁明显增厚的软组织影。采用腹腔镜下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。采用腹腔镜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 5 0 0 g ,术后病理报告为成熟的脂肪组织。术后 1周出院。 2周后复查B超示双肾输尿管积水减轻 ,右肾液性暗区最大直径由术前 2 .9cm降至 2 .0cm ,右侧输尿管上段扩张直径由 1.2cm降至 1.0cm ,左侧肾积水由 1.8cm降至 1.3cm ,左侧输尿管上段扩张直径由 0 .8cm降至 0 .5cm。 结论 X线、CT及MRI为此病的主要诊断线索及依据 ,腹腔镜下剔除盆腔及输尿管周围脂肪加输尿管松解术是治疗此病的有效和微创的方法。

Objective To improve the awareness of pel vi c lipomatosis in clinical practice. Methods A 51-year- old male patient with pelvic lipomatosis was admitted. Imaging studies showed th at there was mild degree of hydronephrosis on his both sides on IVU and a typica l inverted-pear shape of bladder and extended posterior urethra were also seen on IVU.CT scan showed that low density lipid piled in the pelvic cavity.MRI show ed obvious thickened soft tissue lesion around the bladder,rectum and in the pel vic cavity. The lesions in the pelvic cavity and around the ureters were removed and the lower segments of the ureters were loosened by laparoscopic surgery. Th e clinical characteristics of lipomatosis were reviewed by combination with the literature. Results Intraoperatively,apparently increase d lipid tissue was found in the pelvic cavity and there was large amount of lipi d tissue filling the space around bladder,rectum and sigmoid colon.This finding was consistent with the imaging study findings.About 500g lipid tissue was remov ed in the laparoscopic procedure.Pathologic study showed it was mature lipid tis sue.The patient was discharged 1 week after surgery.Two weeks after surgery,B-u ltrasound showed that there was improvement of hydronephrosis on both sides.The maximum width of right renal fluid sonolucent area decreased from 2.9 cm to 2.0 cm;the width of right upper ureter decreased from 1.2 cm to 1.0 cm;the maximum w idth of left renal pelvis decreased from 1.8 cm to 1.3 cm;and the width of left upper ureter decreased from 0.8 cm to 0.5 cm. Conclusions X-ray,CT scan and MRI are the most valuable examinations in the diagnosis of lipomatosis.Removing the lipid in the pelvis and around the bladder and loosenin g the ureters by laparoscopic surgery are minimally invasive,safe and effective in the treatment of pelvic lipomatosis.