良性对称性脂肪瘤病的诊断和治疗(附6例报告)

Recent progress on diagnosis and treatment of benign symmetric lipomatosis

目的:探讨良性对称性脂肪瘤病(BSL)的诊断和治疗。方法:结合我院收治的6例BSL患者,回顾性分析BSL的临床症状、体征、诊断及治疗,并结合文献进行探讨。结果:6例均以颈项部大量皮下脂肪堆积为主要表现,其中1例伴有双侧上臂近肘窝处皮下脂肪堆积呈对称性隆起。6例患者伴左心舒张功能改变、糖耐量减低、阻塞性睡眠呼吸暂停低通气综合征、Ⅱ型糖尿病及高尿酸血症中的1项或多项,其中1例患者同时出现上述症状,除1例女性患者未见肝功能改变外其余5例男性患者均出现。5例男性患者均有长期酗酒史。除1例拒绝治疗外,其余5例行彻底切除术及戒酒,术后随访3个月～4年,1例术后3年后复发,未行再次治疗,其余4例无复发。所有患者术后病理诊断为无包膜脂肪组织。结论:BSL是一种脂肪代谢障碍引起的脂肪组织弥漫性、对称性沉积于颈肩部皮下浅筋膜间隙和(或)深筋膜间隙的良性疾病。患者以中年男性居多,长期的酗酒史及典型的临床表现对于该病的诊断有一定帮助,对于影响美观及功能的患者手术疗效较理想。

Objective：To introduce recent progress on diagnosis and treatment of benign symmetric lipomatosis（BSL）.Method：Detailed clinical data of 6 patients with BSL were reviewed and analyzed.We present a summary of the clinical symptoms,physical sign,diagnosis and therapeutic methods of BSL. And related literatures were discussed together.Result：All of 6 patients have excessive subcutaneous fat deposit predominantly around neck.One patients had upper extremity localizations. Six patients had the complication of left ventricular diastolic function changes,glucose intolerance or diabetes mellitus,chronic hepatopathy,hyperuricemia and sleep apnea syndrome in one or more. One patients with several symptoms occur simultaneously,another one female patient was accompanied by all symptoms but chronic hepatopathy. Five male patient were alcohol abusers. Tatal neck lipentomy and abstinence from alcohol were performed on 5 patients. One patient refused treatment.During a follow-up of 3 months to 4 years,one patients was relapsed again,and no recurrence was seen in another 4 patients. All pathological results were nonencapsulated fat. Conclusion：BSL is a lipodystrophy caused by diffuse fatty tissue,symmetry deposition in the neck and shoulder subcutaneous fascia space or deep fascial space.The highest incidence favors to middle-aged man who is alcoholist. Chronic alcohol addiction and typical clinical symptoms help to diagnosis BSL. Lipectomy represents a successful procedure in treating BSL.