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。     

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。     

盆腔脂肪增多症诊治分析

目的 提高盆腔脂肪增多症的认识。方法 收治盆腔脂肪增多症1例，男，51岁。影像学主要表现为：IVU示双肾轻度积水，典型倒梨形膀胱、后尿道延长；CT示盆腔内均匀低密度脂肪堆积；MRI示膀胱、直肠周围及盆壁明显增厚的软组织影。采用腹腔镜下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。采用腹腔镜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500g，术后病理报告为成熟的脂肪组织。术后1周出院。2周后复查B超示双肾输尿管积水减轻，右肾液性暗区最大直径由术前2．9cm降至2．0cm，右侧输尿管上段扩张直径由1．2cm降至1．0cm，左侧肾积水由1．8cm降至1．3cm，左侧输尿管上段扩张直径由0．8cm降至0．5cm。结论 X线、CT及MRI为此病的主要诊断线索及依据，腹腔镜下剔除盆腔及输尿管周围脂肪加输尿管松解术是治疗此病的有效和微创的方法。     

盆腔脂肪增多症的诊断和治疗

目的：探讨盆腔脂肪增多症的诊断和治疗方法。方法：回顾性分析我院5例盆腔脂肪增多症患者诊断和治疗的临床资料，并复习文献就本病的临床特点进行分析。结果：5例患者均经影像学和病理检查确诊。3例患者行手术治疗而获痊愈，随访至今效果良好；1例患者行双肾穿刺造瘘术后症状缓解，现仍生存；1例患者自动出院失访。结论：盆腔脂肪增多症在影像学上有其特征性的表现，是其诊断的主要依据。手术彻底清除异常增生的脂肪是首选的治疗方法。     

聚丙烯网带经第12肋悬吊术治疗肾下垂七例报告

目的 探讨聚丙烯网带经第12肋悬吊术治疗肾下垂的手术疗效.方法 肾下垂患者7例.男2例,女5例.年龄14～46岁.身高150～183 cm,体质量45～68 kg.右侧5例,左侧1例,双侧1例.均经B超、CT、站立位IVu检查确诊,肾下垂放射学分度Ⅱ度1例、Ⅲ度3例、Ⅳ度3例.手术经腰肋切口,采用聚丙烯网带经肾纤维囊和脂肪囊之间绕过肾脏及其下极,调整网带长度至肾脏恢复正常解剖位置,将两端穿过第12肋后用丝线缝扎固定.IVu复查比较手术前后肾脏位置.结果 7例患者手术顺利,平均手术时间65(50～90)min,平均住院时间8(7～9)d,平均卧床时间7(6～8)d.患者术前腰酸、腰痛、血尿、尿频、尿急等症状完全消失.术后随访12～36个月,平均24个月,IVu示患.肾均恢复至正常位置.4例肾积水患者中,1例中重度积水者积水明显减轻,肾脏形态基本恢复正常,余3例完全恢复正常;1例反复尿路感染者,尿沉渣细胞学复查阴性,尿路刺激症状消失;1例阵发性血尿者血尿消失;1例合并Dietl危象者术后症状消失.结论 聚丙烯网带经第12肋肾脏悬吊术治疗肾下垂简单易行、操作安全、并发症少,治愈率高.     

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。     

盆腔脂肪增多症的影像学诊断(附4例报告)

目的 :提高对盆腔脂肪增多症的认识及诊断水平。方法 :回顾性分析了 4例经手术及病理检查证实的盆腔脂肪增多症的 X线、CT和 MRI表现。结果 :影像学表现与术中见膀胱、直肠、前列腺等脏器受压后移位、变形相一致。结论 :影像学检查为诊断盆腔脂肪增多症的主要方法和依据     

下腔静脉后输尿管的影像学协同诊断与手术矫正

目的：提高下腔静脉后输尿管的影像学协同诊断与治疗水平。方法：对11例下腔静脉后输尿管临床资料进行回顾性分析。结果：11例均于术前采用B超、KUB加IVP、逆行肾盂造影等检查而确诊，治疗采用输尿管复位矫正术，术后3～6个月复查临床症状消失，肾积水不同程度减轻，吻合口无狭窄。结论：下腔静脉后输尿管诊断主要依据多种影像学的协同检查，逆行肾盂造影是诊断下腔静脉后输尿管最可靠的方法，采用输尿管复位矫正术能取得良好疗效。     

腔内双重双J管内引流治疗输尿管狭窄

目的 探讨腔内留置双重双J管内引流治疗输尿管狭窄的安全性和有效性.方法 我院2008年5月至2010年1月收治12例输尿管狭窄患者,采用输尿管镜下腔内留置2根相同大小双J管(F4～F6)内引流治疗各种原因导致的输尿管狭窄.结果 12例术后留置双J管2～6个月,平均3个月;12例随访2～12个月,平均8个月,其中11例患者拔管前后无腰腹胀痛、发热、血尿等并发症,术后5～7d复查KUB平片示无双J管移位,IVP和B超示肾积水较前明显减轻或无肾积水,双J管引流通畅;1例患者由于反复血尿、腰痛,复查B超和IVP示无梗阻和积水,于术后1个月拔除双J管,血尿症状消失而治愈.结论 腔内留置双重双J管内引流治疗输尿管狭窄安全有效,但远期效果和相关并发症有待于大样本进一步研究验证.     

肾局限性脉管结构不良引起血尿一例报告

肾局限性脉管结构不良引起血尿一例报告郝吉祥，高振中患者，女，３５岁。因间断无痛性全程肉眼血尿１０年，于１９９４年１月７日入院。入院前１０年无明显诱因出现全程无痛性肉眼血尿伴条索状血块，给予止血、抗炎药物治疗后症状消失。入院前半个月再次出现上述症状伴阵...     

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.     

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.     

泌尿系子宫内膜异位症临床诊治特点分析

目的 探讨泌尿系子宫内膜异位症的临床诊治特点.方法 女性泌尿系子宫内膜异位症患者10例.平均年龄39(28～49)岁.病史6个月～3年.膀胱子宫内膜异位症4例,临床表现为月经期尿路刺激症、下腹部坠痛不适感,其中伴肉眼血尿1例.B超、CT检查提示膀胱占位病变直径2.0～3.5 cm.输尿管子宫内膜异位症6例,左侧4例,右侧2例.临床表现为腰腹部不适4例,间断无痛性肉眼血尿1例,查体B超偶然发现肾积水1例.B超检查肾盂分离2.0～4.5 cm,输尿管中上段扩张1.0～2.0 cm,其中1例输尿管下端占位伴肾重度积水;CT检查输尿管下段狭窄5例,长度2.0～3.0 cm;输尿管下段占位病变1例.结果 10例均行手术治疗.膀胱部分切除4例,其中同时切除双卵巢、子宫1例;输尿管部分切除输尿管膀胱吻合术3例,输尿管端端吻合术2例,肾输尿管全长切除1例.术后病理诊断均为子宫内膜异位症.术后9例服用17α-乙炔睾丸酮200 mg,2次/d,持续6～12个月.10例患者随访12～60个月,8例恢复良好;2例输尿管子宫内膜异位症患者术后18、24个月复发,予内置输尿管支架管,分别口服17α-乙炔睾丸酮及注射戈舍瑞林治疗3个月后症状缓解.结论 泌尿系子宫内膜异位症多无特异性表现,术前确诊困难,手术切除病灶效果好,辅助药物治疗可预防复发.     

泌尿系子宫内膜异位症临床诊治特点分析

目的 探讨泌尿系子宫内膜异位症的临床诊治特点.方法 女性泌尿系子宫内膜异位症患者10例.平均年龄39(28～49)岁.病史6个月～3年.膀胱子宫内膜异位症4例,临床表现为月经期尿路刺激症、下腹部坠痛不适感,其中伴肉眼血尿1例.B超、CT检查提示膀胱占位病变直径2.0～3.5 cm.输尿管子宫内膜异位症6例,左侧4例,右侧2例.临床表现为腰腹部不适4例,间断无痛性肉眼血尿1例,查体B超偶然发现肾积水1例.B超检查肾盂分离2.0～4.5 cm,输尿管中上段扩张1.0～2.0 cm,其中1例输尿管下端占位伴肾重度积水;CT检查输尿管下段狭窄5例,长度2.0～3.0 cm;输尿管下段占位病变1例.结果 10例均行手术治疗.膀胱部分切除4例,其中同时切除双卵巢、子宫1例;输尿管部分切除输尿管膀胱吻合术3例,输尿管端端吻合术2例,肾输尿管全长切除1例.术后病理诊断均为子宫内膜异位症.术后9例服用17α-乙炔睾丸酮200 mg,2次/d,持续6～12个月.10例患者随访12～60个月,8例恢复良好;2例输尿管子宫内膜异位症患者术后18、24个月复发,予内置输尿管支架管,分别口服17α-乙炔睾丸酮及注射戈舍瑞林治疗3个月后症状缓解.结论 泌尿系子宫内膜异位症多无特异性表现,术前确诊困难,手术切除病灶效果好,辅助药物治疗可预防复发.     

泌尿系子宫内膜异位症临床诊治特点分析

目的 探讨泌尿系子宫内膜异位症的临床诊治特点.方法 女性泌尿系子宫内膜异位症患者10例.平均年龄39(28～49)岁.病史6个月～3年.膀胱子宫内膜异位症4例,临床表现为月经期尿路刺激症、下腹部坠痛不适感,其中伴肉眼血尿1例.B超、CT检查提示膀胱占位病变直径2.0～3.5 cm.输尿管子宫内膜异位症6例,左侧4例,右侧2例.临床表现为腰腹部不适4例,间断无痛性肉眼血尿1例,查体B超偶然发现肾积水1例.B超检查肾盂分离2.0～4.5 cm,输尿管中上段扩张1.0～2.0 cm,其中1例输尿管下端占位伴肾重度积水;CT检查输尿管下段狭窄5例,长度2.0～3.0 cm;输尿管下段占位病变1例.结果 10例均行手术治疗.膀胱部分切除4例,其中同时切除双卵巢、子宫1例;输尿管部分切除输尿管膀胱吻合术3例,输尿管端端吻合术2例,肾输尿管全长切除1例.术后病理诊断均为子宫内膜异位症.术后9例服用17α-乙炔睾丸酮200 mg,2次/d,持续6～12个月.10例患者随访12～60个月,8例恢复良好;2例输尿管子宫内膜异位症患者术后18、24个月复发,予内置输尿管支架管,分别口服17α-乙炔睾丸酮及注射戈舍瑞林治疗3个月后症状缓解.结论 泌尿系子宫内膜异位症多无特异性表现,术前确诊困难,手术切除病灶效果好,辅助药物治疗可预防复发.     

A case of emphysematous cystitis: a case report

A 86-year-old woman presented with asymptomatic gross hematuria,and visited our hospital, and a vesicorectal fistula was suspected from a computed tomographic (CT) scan. She had a lower abdominal mass and urinary retention on arrival. Pclvic CT demonstrated intramural gas in the urinary bladder,which suggested a diagnosis of emphysematous cystitis. Cystoscopy demonstrated reddish mucosa and gas within the bladder wall. The gross hematuria was improved and the intramural gas disappeared on a CT scan after urinary drainage and antibiotic therapy. Although emphysematous cystitis is almost always cured with conservative therapy, an accurate diagonosis and prompt treatment are required because rarely emphysematous cystitis can result in rupture of the urinary bladder and lead to septic shock.     

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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.     

经尿道肿瘤剜除术治疗黏膜下型膀胱平滑肌瘤初探

目的 探讨经尿道肿瘤剜除术治疗黏膜下型膀胱平滑肌瘤的疗效及安全性。 方法 回顾性分析6例黏膜下型膀胱平滑肌瘤患者的临床资料。男2例,女4例。年龄32 ～ 78岁,平均59岁。表现为排尿梗阻3例,排尿刺激症状1例,肉眼血尿1例及无临床症状、体检发现1例。病程1周～4年,平均23个月。B超检查均发现膀胱内占位性病变,肿瘤平均最大直径3.0(2.0 ～3.5)cm。CT检查示肿瘤形态完整,增强后较均匀轻度强化。4例IVU检查发现膀胱充盈缺损。6例膀胱镜检查均提示膀胱黏膜下占位,黏膜表面光滑。6例均行膀胱镜下穿刺活检病理检查,诊断为膀胱平滑肌瘤,后行经尿道膀胱肿瘤剜除术（2例位于侧壁、体积较小肿瘤以激光剜除,4例体积较大肿瘤以电切镜剜除）。肿瘤基底部活检后,电灼肿瘤基底及创缘。 结果 6例手术均顺利完成,无膀胱穿孔等并发症。术后患者均排尿通畅,排尿刺激症状明显缓解,血尿消失。术后中位随访时间58(4～158)个月,未见肿瘤复发或转移。 结论 病理检查是确诊黏膜下型膀胱平滑肌瘤的主要手段。经尿道肿瘤剜除术治疗黏膜下型膀胱平滑肌瘤安全有效。     

肾移植术后并发双侧自体肾盂和输尿管移行细胞癌16例

目的 总结肾移植术后发生双侧自体肾盂、输尿管移行细胞癌的诊治经验.方法 回顾性分析16例肾移植术后发生双侧自体肾盂、输尿管移行细胞癌患者的资料.首次发现上尿路肿瘤的时间为移植后(56.2±33.0)个月.2例同时发现双侧上尿路肿瘤,其余14例双侧上尿路肿瘤先后发现的时间间隔为(8.6±6.7)个月.临床症状和检查阳性结果以血尿和自体肾积水为主.均行自体上尿路根治性切除术,术后行膀胱灌注化疗.结果 16例手术均成功.32次自体肾、输尿管的病理检查结果均为移行细胞癌,包括单纯肾盂肿瘤4次,单纯输尿管肿瘤9次,合并肾盂、输尿管肿瘤19次.23次肾盂肿瘤的分级为1级8例,2级11例,3级4例;28次输尿管肿瘤的分级为1级6例,2级10例,3级12例.术后随访(26.8±25.1)个月,1例出现肺部转移后死亡;1例发生腰背部软组织转移性移行细胞癌,局部切除;其他患者未发现肿瘤复发及转移.结论 肾移植后自体上尿路移行细胞癌的常见表现为血尿合并自体肾积水,该肿瘤侵袭性较强,对于膀胱及一侧自体上尿路同时存在移行细胞癌者,应行对侧自体肾上尿路预防性切除术.

Abstract：

Objective To investigate the clinical features of bilateral native pelvic and ureteral transitional cell carcinoma (TCC) in renal transplant patients. Methods A retrospective analysis was carried out on 16 patients with bilateral native pelvic and ureteral TCC after kidney transplantation.The mean time between transplantation and diagnosis of upper urinary TCC was 56. 2 ± 33. 0 months.Two patients were suffered from bilateral upper urinary TCC at the same time. The mean interval between 2 upper urinary tract operations of the remaining 14 cases was 8. 6 ± 6. 7 months. Hematuria and hydronephrosis of native kidneys were the main symptoms and targets in checkup. Intravesical chemotherapy was postoperatively given. Results All operations were performed successfully. All specimens obtained from the operations were pathologically diagnosed as TCC. The TCC location involved pure native pelvis (n = 4), pure native ureter (n = 9), and pelvis combined with ureter (n = 19). Pelvic TCC pathological grades included grade 1 in 8 cases, grade 2 in 11 cases, and grade 3 in 4 cases; Ureteral TCC grades included grade 1 in 6 cases, grade 2 in 10 cases, and grade 3 in 12 cases.Patients were followed up for 26. 8 ± 25. 1 months. One patient died of lung metastasis. (One case of lumbar soft tissue transfer was given local excision. The remaining patients had no recurrence and metastasis. Conclusion Renal transplant patients with hematuria and native renal hydronephrosis should be highly vigilant of the occurrence of upper urinary tract TCC. TCC after renal transplantation is invasive. Prophylactic contralateral nephroureterectomy should be performed on the recipients having TCC at the bladder and one side of native upper urinary tract.