1 conservative treatment Although it has been reported at home and abroad, various conservative treatment methods have achieved certain results, including long-term oral antibiotics and diet control. All of them are case reports and the follow-up time is short, and the effect is minimal and inaccurate. Foreign scholars have reported that hormone therapy and external radiotherapy have poor results.
Surgical treatment is mainly aimed at severe hydronephrosis or sigmoid colon obstruction caused by urinary tract obstruction. The ideal method is to remove excess adipose tissue and release the narrow ureter. However, because of the rich blood supply and rich fiber in adipose tissue, it is difficult to find the peeling plane during the operation, and the operation is easy to cause pelvic organ damage. Most scholars advocate urinary diversion and transurethral resection of prostate or bladder neck. Klein and others advocated that patients should be divided into young group and old group. The former is more robust, with bladder morphological changes and bladder irritation symptoms, and the disease develops rapidly, and urinary tract obstruction or uremia occurs earlier, so surgical intervention should be carried out as soon as possible. The latter develops slowly and can remain unchanged for more than 10 years. Regular follow-up, once every six months 1 renal function examination, once every two years 1 angiography examination, cystoscopy examination and operation regularly if necessary. There are sporadic reports at home and abroad that there is no recurrence after open pelvic liposuction treatment. Cheng Jiyi and others reported that 4 cases (65,438+0 cases) underwent open surgery to remove excessive adipose tissue around the bladder and release bilateral pelvic ureters to the bladder. Follow-up for 8 months showed good results. Feng Li et al. also reported that 1 patients' blood pressure returned to normal after operation. Halachmi et al reported 1 case of open operation to release and cut off the anastomosis between ureter and bladder top, and plastic surgery used ultrasonic grease instrument to suck adipose tissue, which also achieved good results.
The key to surgical treatment of this disease is to protect the blood supply of ureter, avoid urinary fistula or damage to ureter caused by insufficient blood supply of ureter, keep pelvic drainage tube for adequate drainage after operation, and choose effective antibiotics to prevent infection. In this case, besides removing excessive adipose tissue around the bladder, releasing the bilateral ureters to the bladder inlet, opening the bladder, carrying out internal incision of the bladder neck, and placing catheters on the bilateral ureters, the postoperative recovery was smooth, with no complications and satisfactory short-term curative effect. However, whether the patient can not relapse or progress in the future needs long-term follow-up observation.