盆腔脂肪增多症两例报告  

Pelvic lipomatosis:report of two cases

作　　者：张勇[1] 刘君昌 高小林 姜泰茂 Zhang Yong;Liu Junchang;Gao Xiaolin;Jiang Taimao(Department of Urology,Air Force Hospital of the Northern Theater of the Chinese People’s Liberation Army,Shenyang 110042,China)

机构地区：[1]中国人民解放军北部战区空军医院泌尿外科,沈阳110042 [2]锦州医科大学中国人民解放军北部战区空军医院研究生规培基地,沈阳110042

出　　处：《新医学》2021年第1期64-69,共6页Journal of New Medicine

摘　　要：盆腔脂肪增多症(PL)指盆腔脂肪组织过度增生,盆腔脂肪组织包绕并压迫周围器官,使之形状和位置发生改变,导致泌尿系统及下消化道发生梗阻,从而产生一系列临床症状。该文回顾性分析2例PL患者的临床资料,2例患者均因尿频、尿急为主诉就诊,经影像学检查确诊为PL。例1年轻患者临床症状较重,早期行膀胱镜检查取病理组织提示腺性膀胱炎,给予膀胱灌注治疗,后期患者临床症状加重,行经尿道腺性膀胱炎电切+盆腔脂肪清除术+双侧输尿管膀胱再植术,术后随访肾盂输尿管积水较术前明显减轻,远期效果满意。例2老年患者临床症状较轻且身体状况欠佳,给予保守治疗,随访1年,双肾输尿管积水未见明显减轻,症状略缓解。该2例的诊治过程提示,PL的影像学检查有其特征性的表现,对于病情进展缓慢且肾功能良好的患者可定期随访观察,对于年龄较大或身体条件不允许的患者可考虑行尿流改造术改善症状。对于病情重的年轻患者应以解除梗阻症状、改善患者生活质量为目的,解除盆腔脂肪对膀胱、输尿管及结直肠的压迫,改善尿路梗阻造成的严重肾积水甚至肾衰竭及消化道症状。Pelvic lipomatosis(PL)is an overgrowth of pelvic adipose tissue,which surrounds and compresses the surrounding organs and changes its shape and position,resulting in obstruction of urinary system and lower digestive tract,thus a series of clinical symptoms.In this article,clinical data of 2 cases of PL was retrospectively analyzed.Two patients were admitted to our hospital due to the chief complaint of urine frequency and urgency,and diagnosed with PL by imaging examination.Case 1 was a young patient with severe clinical symptoms.Preliminary cystoscopy combined with pathological examination prompted the signs of glandular cystitis,and bladder perfusion treatment was delivered.In the late stage,relevant clinical symptoms of this patient were aggravated,and the patient underwent transurethral cystitis glandular resection+pelvic fat removal+bilateral ureterovesical replantation.Postoperative follow-up revealed that hydronephrosis was significantly relieved after surgery.The long-term results were satisfactory.Case 2 was an elderly patient presented with mild clinical symptoms and poor physical condition.Conservative treatment was given.The patient was followed up for 1 year,and the hydroureter of bilateral kidneys was not significantly alleviated,whereas relevant symptoms were slightly mitigated.These two cases prompted that PL is characterized with unique imaging features.Patients with slow progression and normal kidney function can be followed up on a regular basis.For elderly patients with poor physical conditions,urological modification surgery is recommended to improve relevant symptoms.For young patients with severe disease,it is of significance to relieve the obstruction symptoms,improve the quality of life,reduce the compression of pelvic fat on bladder,ureter and colorectal,and mitigate the symptoms of severe hydroureter and even renal failure or digestive tract symptoms caused by urinary tract obstruction.

关 键 词：盆腔脂肪增多症 肾积水 尿路梗阻 

分 类 号：R699[医药卫生—泌尿科学]