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目的:探讨盆腔脂肪增多症的临床特征及治疗手段。方法:本院泌尿外科收治盆腔脂肪增多症1例,男,50岁。影像学主要表现为:IVU示双肾中度积水,典型倒梨形膀胱、后尿道延长;CT示双肾功能减退,双肾积液,左肾萎缩,盆腔内均匀低密度脂肪堆积。采用剖腹探查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。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200 g,术后病理报告为脂肪组织瘤样增生。术后1周出院。门诊随诊观察。结论:盆腔脂肪增多症临床罕见报道,X线、CT及MRI为此病的主要诊断线索及依据;对肾积水及肾功能受损患者可行定期留置、更换D-J管,盆腔脂肪清除及输尿管粘连松解或输尿管膀胱再植是切实的治疗方法,若症状无改善最终应行尿流改道手术。
Objective: To investigate the clinical features and treatment of pelvic fat disease. Methods: The hospital urology admitted pelvic fat disease in 1 case, male, 50 years old. Imaging showed mainly as: IVU showed moderate hydronephrosis, typically inverted pear-shaped bladder, posterior urethra extension; CT showed renal dysfunction, hydronephrosis, left renal atrophy, pelvic uniform low-density fat accumulation. Using laparotomy to clear the pelvis and ureter around the adipose tissue, loosen the lower ureter method of treatment. Combined with the literature review to discuss the diagnosis and treatment of pelvic fat disease characteristics. Results: The intraoperative visceral adipose tissue was significantly increased, around the bladder, rectum and sigmoid colon filled with a large number of adipose tissue, consistent with the imaging findings. Surgical removal of pelvic and ureter around the fat plus ureteral lysis, removal of adipose tissue about 200 g, postoperative pathological reports of adipose tissue tumor-like hyperplasia. One week after the discharge. Outpatient follow-up observation. Conclusion: The clinical manifestations of pelvic fat disease rarely seen, X-ray, CT and MRI diagnosis of the disease as the main clues and basis for hydronephrosis and impaired renal function may be scheduled for regular replacement, replacement of DJ tube, pelvic fat removal and ureteral adhesions Loose or ureteral bladder replantation is an effective treatment, if the symptoms did not improve the final urinary diversion surgery should be performed.