颈部对称性脂肪瘤的诊治

【】　目的　探讨颈部对称性脂肪瘤的诊断和治疗。　方法　对2004年3月-2010年10月收治的5例颈项部脂肪瘤患者，其临床症状、体征、术前术后处理及结果等临床资料进行回顾。　结果　5例均为男性，以颈、项部大量皮下脂肪堆积为主要临床表现，其中1例伴有胸部上分皮下脂肪堆积，呈对称性隆起。3例患者伴阻塞性睡眠呼吸暂停低通气综合征，2例患者有睡眠打鼾但无明显呼吸暂停。4例患者有脂肪肝和长期酗酒史，但肝功能无异常改变，其中1例（1/4）有多次乙醇中毒史。1例患者无酗酒史，但诉经常作颈部刮痧治疗。5例均行外科手术切除，术中见肿瘤为白色无包膜脂肪组织。术后随访3个月~2年，1例术后1年复发，未行再次治疗，其余未见明显复发。　结论　颈部对称性脂肪瘤是脂肪组织弥漫性、对称性沉积于颈胸部皮下浅筋膜间隙和（或）深筋膜间隙的良性疾病。患者以中年男性居多，长期的酗酒史及典型的临床表现对于该病的诊断有一定帮助，但酗酒可能并非唯一病因。对于影响美观及功能的患者，其手术疗效较理想。【Abstract】　Objective　Toexplorethediagnosisandtreatmentofsymmetriclipomatosisintheneck.　Methods　Weretrospectivelyanalyzedtheclinicalmanifestations,signs,preoperativeandpostoperativemanagement,andthetreatmentoutcomeoffivepatientswithsymmetriclipomatosishospitalizedintheDepartmentofOtolaryngology-HeadandNeckSurgeryofWestChinaHospitalbetweenMarch2004andOctober2010.　Results　Allthefivepatientsaremalewithalargequantityofsubcutaneousfatdepositinandaroundtheneck.Amongthem,onepatientdemonstratedextendingupperthoraxmassintheformofsymmetricalapophysis;threeexperiencedobstructivesleepapneahypoventilationsyndrome,andtwohadthesymptomofsnoringwithoutapnea.Fourpatientshadalonghistoryofalcoholabusewithfattyliver,buthadnoliverdysfunction.Inthesefourpatients,onehadalcoholismformanytimes.Oneoutofthefivepatientshadnohistoryofalcoholabuse,butsaidtohavebeentreatedbyatraditionalChinesemedicaltechniqueGUASHA.Allthepatientsunderwentresectionsurgery,duringwhichalargeamountofnoncapsulatedwhiteadiposetissuewasconfronted.Thedurationoffollow-uplastedfromthreemonthstotwoyears.Therewasonecaseofrecurrenceoneyearafterthesurgeryandthepatientrefusedre-operation.Noobviousrecurrencewasfoundintherestofthegroup.　Conclusions　Symmetriclipomatosisisabenignlesioncharacterizedbydiffusedandsymmetricaccumulationofadiposetissueinthesuperficialordeepfasciaspaceinthecervico-thoracicregion.Itmainlytakesplaceinthemiddle-agedpeople.Longhistoryofalcoholabuseandtypicalclinicalmanifestationscanhelptoreachthediagnosis,butalcoholismmaynotbetheonlycauseinetiology.Surgerymaybethefeasibletherapeuticmodalityuptonow.