盆腔脂肪增多症的诊断和治疗

目的提高对盆腔脂肪增多症的诊治水平。方法回顾性分析5例盆腔脂肪增多症的临床症状、影像学表现和治疗结果，结合文献复习讨论盆腔脂肪增多症诊治特点。结果术中可见盆腔脂肪组织明显增多，膀胱输尿管周围充满大量脂肪组织，与影像学表现一致，术后病理报告为成熟的脂肪组织。术后复查B超示双肾、输尿管积水减轻。结论X线、CT及MRI为本病的主要诊断依据，盆腔脂肪清除、输尿管膀胱再植术是治疗本病的有效方法。     

腹腔镜手术治疗盆腔脂肪增多症1例报告并文献复习

目的:探讨腹腔镜手术治疗盆腔脂肪增多症的疗效。方法:2014年10月采用腹腔镜手术治疗盆腔脂肪增多症患者1例。结果:术后保留导尿1周,9天后出院,1个月后取出双J管。术后3个月复查,患者下尿路症状明显减轻,B超检查提示双肾积水及输尿管扩张情况较术前好转。结论:腹腔镜手术清除盆腔脂肪并行双侧输尿管膀胱再植术治疗盆腔脂肪增多症疗效满意,具有创伤小、术后恢复快等优点。     

骨盆脂肪增多症

骨盆脂肪增多症牛志宏，刘士怡骨盆脂肪增多症是一种罕见的以骨盆内直肠和膀胱周围间隙成熟脂肪组织大量增生为特征的临床病症。Ｅｎｇｅｌｓ［１］１９５９年首先发现了这种疾病。１９６８年Ｆｏｇｇ等［２］将“骨盆内膀胱，直肠周围正常脂肪组织增生”命名为骨盆脂肪增...     

膀胱肉瘤样癌1例

患者，男，27岁。以无痛性肉眼血尿1月加重1周于2006年11月20日入院。患者自诉1月前无意中发现小便呈洗肉水样，无尿痛及排尿费力，1周前出现尿频（1次／h），小便时可见血块，伴有胀痛，到当地医院行B超检查示膀胱肿瘤（右侧前壁），拟住院手术。术前膀胱镜检查见右侧壁新生物3．0cm×4．0cm，实质性，广基无蒂易出血，距右侧输尿管开口2．0cm，双侧输尿管开口及喷尿均正常。术前静脉肾盂造影示右侧膀胱区3．0cm×4．0cm充盈缺损，双肾无积水，输尿管未见扩张。CT示膀胱右侧前壁3．0cm×4．0cm×3．0cm肿块，盆腔未见肿大淋巴结。术前检查腹股沟未见肿大的淋巴结。     

前列腺小细胞神经内分泌癌1例

患者,男,32岁。因尿频、夜尿增多伴腰骶部疼痛1个月,于2005年8月25日入院。直肠指检:前列腺Ⅰ度大,右侧叶触及约4cm×2cm大小包块,质地中等,表面光滑。PSA0·45μg/L,肝肾功能及胸片无异常。CT示盆腔内占位,考虑恶性肿瘤,右肾盂、输尿管扩张积水为肿块压迫膀胱三角区所致。行盆     

先天性膀胱并前列腺异位1例

患者男，48岁。因B超发现左肾积水2周入院。直肠指检未扪及前列腺。门诊B超示左肾重度积水，输尿管上段扩张．脂肪肝；经直肠B超未发现前列腺。KUB加IVP以及大剂鼠KUB加IVP示左肾重度积水。左输尿管未显影(图1)；脐尿管囊肿或膀胱异位?初步诊断为：①左肾重度积水；②     

腹腔镜输尿管膀胱吻合术治疗内在型输尿管子宫内膜异位症12例

目的 评价腹腔镜输尿管膀胱吻合术治疗输尿管子宫内膜异位症（内异症）合并重度肾积水的有效性和安全性.方法 回顾性分析2012年2月至2013年12月在中山大学附属第一医院妇科收治的12例合并重度肾积水的深部浸润型内异症（DIE）患者的临床资料,包括患者的术前症状、术前肾积水直径、手术时间、术中出血量、切除病变输尿管长度、病灶距离膀胱的长度、术后住院天数和并发症等.结果 12例患者均在腹腔镜下完成患侧输尿管狭窄部分节段切除术并输尿管膀胱吻合术和盆腔内异症根治术.术前肾积水直径平均为8.85 cm,手术时间为平均361 min,术中出血量平均为429ml,切除输尿管的长度平均为2.26 cm,病灶距离膀胱的长度平均为4.36 cm,平均术后住院天数为12.45 d.发生并发症5例（41.67％）.术后全部患者疼痛症状明显减轻或消失,肾盂积水明显好转.结论 腹腔镜输尿管膀胱吻合术治疗输尿管内异症合并重度肾积水预后良好,但需警惕并发症的发生.     

盆腔脂肪增多症1例报告

患者,男,40岁。因乏力、纳差1年余于1997年10月10日收入院。体检:血压180/120mmHg(1mmHg=0.133kPa),下腹稍膨隆,膀胱镜未能置入。IVU于7min时双肾未显影,以后显示双肾及输尿管积水、扭曲、扩张达1.8cm,向下逐渐变细,膀胱显影不良。膀胱造影显示膀胱明显抬高,容量达800ml,呈倒泪滴状。CT、MRI示盆腔内脂肪明显增多,其内可见多发条索状密度增高影,双侧输尿管近端增粗,至膀胱壁段处明显变细至显示不清,双侧精囊腺向中线聚拢且相互融合,直肠亦呈细长样改变。ECT显示双肾重度受损。实验室检查:尿素氮291河北省清河县第二人民医院泌尿外科(…     

盆腔脂肪增多症的诊断和治疗

目的：提高对盆腔脂肪症的诊断特点及治疗手段的认识。方法：回顾性分析我科自2011年9月-2012年7月收治的3例盆腔脂肪增多症的临床资料,结合文献复习讨论盆腔脂肪增多症诊治特点。结果：3例患者经尿路平片、静脉肾盂造影、CT和（或）MRI检查诊断后,2例行盆腔脂肪清除加双侧输尿管膀胱再植术,术后病理确诊为盆腔脂肪增多症,随访至今手术效果满意。1例拒绝手术自动出院,随访1年,病情未见缓解。结论：X线、CT及MRI是诊断本病的重要线索和依据。盆腔脂肪清除加双侧输尿管膀胱再植术是治疗盆腔脂肪增多症的有效方法。     

急性原发性非特异性输尿管炎1例报告

患者，女，39岁。因右腰酸痛4d，经解痉、止痛治疗无效后入院。体检：体温38．1℃，右肾区有轻微叩击痛。尿常规：隐血试验（H），白细胞满视野，蛋白定性阴性。B超检查示右肾轻度积水，右输尿管直径1cm。行抗感染、解痉治疗，3d后出现腰痛加剧，尤以大量饮水及输液后为甚，且同时伴体温升高，输液前后体温之差达2．ZC，辅以地塞米松10m尽静脉滴注，体温降至38．4C，但腰痛无缓解。体检发现有肾区触痛和叩痛明显。尿常规：隐血试验、白细胞、蛋白定性均阴性。IVU见右肾增大，右输尿管上段直径为1．0cm，下段输尿管约3．5cm未显影，延迟2…     

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??Diagnosis and treatment of pelvic lipomatosis??A report of 5 patients ZHOU Jia-he, PU Jin-xian, PING Ji-gen. Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou 215000,China
Corresponding author ??PU Jin-xian??E-mail??pjx62@sina.com
Abstract Objective To improve diagnosis and treatment of pelvic lipomatosis in clinical practice. Methods There were 5 male patients with pelvic lipomatosis admitted between February 2009 and March 2012 in the First Affiliated Hospital of Soochow University. They were analyzed in the study with combination of the clinical characteristic, imaging studies, diagnosis and treatment. The clinical characteristics of pelvic lipomatosis were reviewed by combination with the literature. Results Ultrasonography showed bladder deformity and bladder position change, around the neck of bladder had a uniform strong echo and extension of ureters, and also hydronephrosis both side; A typical "vertical buld" shape of bladder, elevated bladder and extended posterior were seen on IVU. CT scan showed there were even distribution of low-density adipose tissues in pelvic cavity and varying degree of compression, deformation, displacement and elevation of bladder, part of the vertex of urinary bladder over the sacrum. Three patients underwent pelvic adipose dissection and uretero-grafting surgery, apparently increased lipid tissue was found in the pelvic cavity and there was large amount of lipid tissue around the bladder and ureters during the surgery. One patient underwent transurethral resection of glandular cystitis and double J ureteral catheter placement on ureteroscopy. One patient was followed up regularly. Postoperative hydronephrosis was relieved gradually. Conclusion B ultrasonography, IVU and CT scan are the most valuable examinations in diagnosis of pelvic lipomatons. Open operation and double J ureteral catheter placement are effective treatments of pelvic lipomatosis. The patient with good kidney function can be performed regular follow-up.     

药物治疗盆腔脂肪增多症3例报告

目的口服减肥药物治疗盆腔脂肪增多症3例，探讨该病的诊断、治疗和预后。方珐3例男性患者，年龄38岁、52岁、58岁，行腹部平片、静脉肾盂造影（IVP）、CT，膀胱镜检查。均口服减肥药物治疗。治疗后1、3、6个月门诊复查。结果3例患者均有尿频、尿急、夜尿增多、大便困难等症状。其中1例患者伴有间断肉眼血尿，就诊时影像学诊断双肾积水。减肥药物治疗2周后3位患者的尿路刺激症状开始缓解，半年后体重明显减轻。肾积水患者半年后复查B超显示一侧肾积水消失，一侧肾积水减轻，血尿消失。结论盆腔脂肪增多症是一种少见的疾病，影像学检查可以确诊。减肥药物治疗可能是一种简单、有效、可靠的治疗方法。尽管盆腔脂肪增多症的病理学表现为良性病变，但由于会引起尿路梗阻而带来严重的病理生理后果，对盆腔脂肪增多症患者应以防止并发症的治疗为主，并密切随访。     

A case of combination with proliferative cystitis and pelvic lipomatosis causing bilateral hydronephrosis

A 70-year-old man consulted our hospital complaining of gross hematuria and bilateral hydronephrosis. Cystoscopic findings suggested non-papillary sessile tumor at the bladder neck. CT findings revealed bilateral hydronephrosis caused by the stricture of lower ureters. Tumorous structure existed between bladder and prostate. Abundant fatty tissue was observed around bladder and rectum, the shape of the bladder was distorted to inverted tear-drop and the bladder was transferred anteriorly, showing findings of pelvic lipomatosis. Urethrocystography revealed elongation of prostatic urethra and anterior displacement of the bladder. Transurethral tumor resection was performed under spinal anesthesia. Pathological diagnosis was proliferative cystitis and no malignant cells were observed. Transperineal tumor biopsy also revealed no malignant cells. The patient was followed under administration of "Saireitou" (chinese medicine) and cetirizine hydrochloride, followed by antibiotics and anti-inflammatory enzyme preparations.     

电切镜与腹腔镜联合治疗累及输尿管口的浅表性膀胱肿瘤

目的 探讨电切镜与腹腔镜联合治疗累及输尿管开口的浅表性膀胱肿瘤的治疗效果.方法 累及输尿管开口的浅表性膀胱肿瘤患者12例.男7例,女5例.平均年龄46岁.肿瘤直径0.8～3.0 cm.TNM分期T1s 6例、T1 6例.采用经尿道膀胱肿瘤切除术,切除肿瘤及肿瘤周围0.5～1.0 cm正常膀胱黏膜(包括输尿管开口),深达浅肌层;再应用腹腔镜技术进行膀胱输尿管再植.结果 12例患者手术顺利.平均手术时间2.2 h,平均出血量25 ml.术后3个月拔除双J管,膀胱镜检示输尿管乳头形态良好.术后6个月行IVU及膀胱排泄性造影,输尿管无梗阻,Ⅰ～Ⅱ度输尿管反流2例.术后1年膀胱造影,Ⅰ～Ⅱ度输尿管反流4例,Ⅱ度输尿管反流3例.随访3～24个月,B超和IVU显示中度肾积水1例、轻度肾积水5例.结论 联合腔内技术治疗累及输尿管开口的浅表性膀胱肿瘤是微创、安全有效的手术方法,适于基层医院开展.     

Lipomatosis pelvis

Pelvic lipomatosis is a rare benign disease characterized by increased pelvic fatty tissue of unknown origin, which leads to encroachment on the pelvic organs. This can lead to symptoms due to narrowing of the bladder and in some cases also of the rectum as well as distal obstruction of the ureter. Symptomatic disease seems to occur more commonly in men with unspecific lower urinary tract symptoms, constipation and hydronephrosis. Obstruction of the upper urinary tract necessitates operative treatment. As the etiology is unclear an appropriate causal treatment is not available.     

腹腔镜下离断式肾盂瓣法肾盂成形术15例报告

目的 探讨腹腔镜下离断式肾盂瓣法肾盂成形术治疗肾盂输尿管连接部长段狭窄或修剪狭窄段后吻合有张力的临床效果.方法 2005年1月-2010年5月对8例肾盂输尿管连接部长段狭窄和7例修剪狭窄段后吻合有张力者施行经腹腔途径离断式肾盂瓣法肾盂成形术,充分游离肾盂及狭窄段输尿管后,切除狭窄段输尿管,沿肾盂中部以上外侧缘做一切口,从上斜向下,至距肾实质1 cm,然后将肾盂的下半部分向下翻转形成肾盂瓣,与输尿管间断缝合,多余肾盂在距肾实质1 cm处切除,缝合.结果 15例手术均取得成功,手术时间80-145 min,平均92 min.术中出血量30-100 ml,平均53 ml.术后1-2 d拔除引流管.术后5-6 d拔除导尿管出院,无尿漏.术后4周拔除双J管.15例随访5-50个月,平均25个月,腰部疼痛等症状消失;B超提示肾盂积水明显改善,中度肾积水3例,轻度肾积水9例,无明显肾积水3例;IVU显示肾盂缩小,显影好转,其中12例在15 min内显影,3例显影略有延迟.结论腹腔镜下离断式肾盂瓣法肾盂成形术安全、可行.     

Simplified technique for laparoscopic extravesical ureteral reimplantation in the porcine model

BACKGROUND AND PURPOSE: Laparoscopic intravesical and standard Lich-Gregoir repair have been reported but are technically challenging. Herein, we present our experience with a simplified laparoscopic reimplantation of the ureter to correct vesicoureteral reflux (VUR). MATERIALS AND METHODS: Bilateral VUR was created cystoscopically in six minipigs, as confirmed by a static cystogram 6 weeks later. The laparoscopic extravesical correction of VUR was performed utilizing a full-thickness cystotomy. The ureter was transposed inside the bladder, and a full-thickness bladder closure was performed. No attempt was made to cover the ureter with urothelium. No stents or catheters were utilized postoperatively. Three months after reimplantation, the animals were evaluated with serology, a static cystogram, an intravenous urogram (IVU), and gross pathologic and histopathologic examination. RESULTS: The postoperative cystograms confirmed no reflux in all the reimplanted ureters and residual grade 1 to 3 reflux in the non-reimplanted ureters. All pigs voided normally and were completely continent. Cystoscopic evaluation revealed complete epithelialization over the reimplanted ureter. One surgical complication occurred: the ureter was incorporated into the bladder closure and became obstructed. The IVU in all other pigs demonstrated patent ureters with prompt function. CONCLUSIONS: Laparoscopic reimplantation of the ureter utilizing this modified Lich-Gregoir approach corrected reflux in all animals. The full-thickness bladder incision and intravesical transposition of the ureter greatly simplifies the laparoscopic procedure. This laboratory experience encourages further clinical evaluation in the pediatric population with VUR.     

Pelvic lipomatosis

Pelvic lipomatosis has been defined as an overgrowth of benign mature pelvic fatty tissue of unknown cause. It has a characteristic radiographic appearance which simulates that of a pelvic neoplasm, with a radiolucent pelvis and displacement of the distal ureters, urinary bladder, and rectosigmoid colon. Because several types of malignant neoplasms can cause similar radiographic changes, we strongly believe that a tissue diagnosis of the region in question is justifiable.     

后腹腔镜下肾盂成形术在小儿肾积水手术中的应用

目的总结后腹腔镜下离断式肾盂成形术治疗小儿肾积水的经验。方法2003年12月至2005年9月收治肾积水患儿21例。男15例,女6例,平均年龄6．3岁。左侧14例,右侧7例。B超、IVU、放射性核素肾图检查均提示梗阻位于肾盂输尿管连接处。均采用后腹腔镜下离断式肾盂成形术。结果21例患儿中手术成功19例,中转开放手术2例。手术时间150～230 min,平均185 min。术中平均出血量＜20ml。术后3个月随访B超或放射性核素肾图,肾积水有明显改善。结论后腹腔镜下肾盂成形术有望成为治疗小儿肾积水的可靠方法,远期效果有待进一步随访。