盆腔脂肪增多症8例分析

Clinical analysis of eight cases of pelvic lipomatosis

目的 旨在提高对盆腔脂肪增多症的认识。方法回顾性分析盆腔脂肪增多症病例8例男性（1983年-2006年11月）的临床病理特点，以及治疗情况和预后。年龄为26-64岁（44±11）岁，入院前病程为2-240（95±82）月，随访时间为（15±33）月。接受外科手术治疗5例，手术联合糖皮质激素治疗1例，单用糖皮质激素治疗1例。结果8例中合并腺性膀胱炎4例。临床主要表现为尿频、尿急（3例）、排尿困难（3例）、肉眼血尿（3例）、高血压（5例）。8例均存在肾功能不同程度下降[估算肌酐清除率（Ccr）为76±18mL／min]。8例泌尿系统影像学检查均有异常，直接或间接显示盆腔内脂肪增多，其中6例存在输尿管或者肾盂积水。盆腔组织病理学检查4例，均表现为血管脂肪组织。治疗后症状缓解，肾功能变化不明显。结论盆腔脂肪增多症临床表现多不典型，可伴肾功能损害，诊断主要依赖影像学和病理学检查。

Objective To improve the understanding of pelvic lipomatosis. Methods The clinical features of eight patients （males, aged 26-64years） with pelvic lipomatosis who were admitted to Peking Union Medical College Hospital from 1983 to November 2006 were reviewed. The clinical and pathologic features, treatment and prognosis were analyzed. The course of disease before admission was（95 ± 82）months, The period of follow-up was（ 15 ± 32） months, five cases under went upper tract urinary diversion, one case had urinary tract diversion and received steroids, one case received steroids treatment only. Results Four cases had cystitis glandularis, frequency and urgency of micturition were observed in three cases. Dysuria in three cases, hematuria in three cases, and hypertension in five cases were recorded during the course of disease. Renal insufficiency was observed in all of eight cases （ Mean Ccr was 76 ± 18mL/min）. All cases had abnormal features in their image investigation, which indicated excessive pelvic fat directly or indirectly. Six cases had upper tract distention. Four cases underwent pelvic tissue biopsy. The result of biopsy was fat-vessel tissue. Their symptoms, not renal function, were relieved after treatment. Conclusion The symptoms of pelvic lipomatosis are atypical, they had renal insufficiency, and their diagnosis mainly depends on image investigation and pathologic examination.