【摘要】 目的 提高盆腔脂肪增多症的认识。方法 盆腔脂肪增多症1例，男，32岁。影像学检查：B超及IVU示双肾中度积水，双侧输尿管全程扩张。后尿道延长，膀胱呈“竖直灯泡”状改变。结肠气钡双重造影：乙状结肠及直肠上段向后受压变细。CT示：盆腔内均匀低密度脂肪堆积。双肾盂、肾盏及输尿管扩张明显，前列腺位置抬高。尿动力学检查：最大尿流率25.3ml/s，排尿量114ml，残余尿300ml。膀胱测压；膀胱顺应性正常，非抑制性收缩波较多，逼尿肌功能正常。尿道压正常。采用硬膜外麻醉下剔除膀胱及输尿管周围脂肪组织，松解输尿管下段及双侧输尿管置管方法治疗。结合文献复习讨论盆腔脂肪增多症的特点。结果 硬膜外麻醉下先拟行双侧输尿管置管，进镜后见精阜与膀胱颈间距>10cm，内有多个息肉样物，未找到输尿管开口。退镜后改平卧位，探查见盆腔内膀胱及乙状结肠周围充满大量脂肪组织，与影像学表现一致。剔除膀胱及输尿管周围多余脂肪组织。同时行双侧输尿管松解。打开膀胱，找到双侧输尿管开口，分别插入8F单“J”管。输尿管管口周围有多个息肉，约1cm×1cm大小,分别电灼之。术后病理报告：盆腔增生纤维，脂肪组织中原壁血管增生。术后1周下床活动，4周拔除双侧单“J”管。分别于术后一周和3个月复查B超和IVU，双肾盂积水和双侧输尿管扩张逐渐减轻。结论 B超、X线、CT为本病的主要诊断依据。开放手术剔除膀胱及输尿管周围脂肪，同时行双侧输尿管松解及置管术是治疗本病的有效方法。

    【关键词】 盆腔脂肪增多症；手术

    A report of pelvic lipomatosis and the reference review

    ZHAO Zhen-meng, LI Ling, MA Hong-jun, et al.

    Department of Urology, First Affiliated Hospital of Kunming Medical College, Kunming 650032, China

    【Abstract】 Objective To improve the awareness of pelvic lipomatosis in clinical practice. Methods A 32-year-old male patient with pelvic lipomatosis was admitted. Imaging studies: There were mid-degree of hydronephrosis both side on B ultrasonography and IVU, and a typical“vertical bulb”shape of bladder and extended posterior were also seen on IVU. The sigmoid colon and upper rectum were pressed backward and narrowed on colic photography. CT scan showed that low density lipid piled in the pelvic cavity. The bilateral renal pelvix and ureter were markedly dilated, the prostate gland was lifted up. Urodynamic examination: The max flow rate 25.3ml/s, urine volume 114ml, residual urine 300ml.The bladder was with increased non-inhibited contract wave, normal resilience and dribbling muscle. The urethral pressure was normal. The lesions in the pelvic cavity and around the ureters were removed and the lower segments of the ureters were loosened under extradural-anesthesia, after which double J tube were placed into the ureters. The clinical characteristics of lipomatosis were reviewed by combination with the literature. Results Under extradural-anesthesia, the cystoscope was placed into the bladder, the seminal colliculus and bladder neck were seen with their distance larger than 10 cm. There were multiple polypoid tissue in the bladder. The bilateral catheterization of ureters can not be carried out because of no finding of the ureter orifice. After taking out of the cystoscope, the patient was taken to decubitus position. Intraoperatively, apparently increased lipid tissue was found in the pelvic cavity and there was large amount of lipid tissue filling the space around bladder, rectum and sigmoid colon, which was consistent with the imaging study findings. Superfluous lipid tissue around the bladder and ureter was removed, synchronously the lower ureters were loosened. Single J tubes (8F) were placed into bilateral ureters. The polyp around the ureter orifice which were about 1cm×1 cm were electronically cauterized. Pathologic study: hyperplastic fibrous tissue in pelvic cavity, Hyperplastic capillary vessel in lipid tissue. The patient was discharged 1 week after surgery, and the single J tubes were pulled out after 3 more weeks. Hydronephrosis and dilation of ureters were gradually relieved according to B ultrasonography and IVU done after 1 week and 3 months. Conclusion B ultrasonography, X-ray and CT scan are the most valuable examination in diagnosis of lipomatosis. Removing the lipid in the pelvis and around the bladder and loosening the ureters, then ureters catheterization by opening operation are effective treatment of pelvic lipomatosis. ......