• 四川大學(xué)華西醫(yī)院（成都，610041） 1 耳鼻咽喉頭頸外科，2 病理科;3 內(nèi)江市東興區(qū)人民醫(yī)院耳鼻喉科;

【摘要】　目的　 探討頸部對稱性脂肪瘤的診斷和治療。　方法　 對2004年3月-2010年10月收治的5例頸項部脂肪瘤患者，其臨床癥狀、體征、術(shù)前術(shù)后處理及結(jié)果等臨床資料進(jìn)行回顧。　結(jié)果　 5例均為男性，以頸、項部大量皮下脂肪堆積為主要臨床表現(xiàn)，其中1例伴有胸部上分皮下脂肪堆積，呈對稱性隆起。3例患者伴阻塞性睡眠呼吸暫停低通氣綜合征，2例患者有睡眠打鼾但無明顯呼吸暫停。4例患者有脂肪肝和長期酗酒史，但肝功能無異常改變，其中1例（1/4）有多次乙醇中毒史。1例患者無酗酒史，但訴經(jīng)常作頸部刮痧治療。5例均行外科手術(shù)切除，術(shù)中見腫瘤為白色無包膜脂肪組織。術(shù)后隨訪3個月~2年，1例術(shù)后1年復(fù)發(fā)，未行再次治療，其余未見明顯復(fù)發(fā)。　結(jié)論　 頸部對稱性脂肪瘤是脂肪組織彌漫性、對稱性沉積于頸胸部皮下淺筋膜間隙和（或）深筋膜間隙的良性疾病?；颊咭灾心昴行跃佣?，長期的酗酒史及典型的臨床表現(xiàn)對于該病的診斷有一定幫助，但酗酒可能并非唯一病因。對于影響美觀及功能的患者，其手術(shù)療效較理想。
【Abstract】　Objective　 To explore the diagnosis and treatment of symmetric lipomatosis in the neck.　Methods　 We retrospectively analyzed the clinical manifestations, signs, preoperative and postoperative management, and the treatment outcome of five patients with symmetric lipomatosis hospitalized in the Department of Otolaryngology-Head and Neck Surgery of West China Hospital between March 2004 and October 2010.　Results　 All the five patients are male with a large quantity of subcutaneous fat deposit in and around the neck. Among them, one patient demonstrated extending upper thorax mass in the form of symmetrical apophysis; three experienced obstructive sleep apnea hypoventilation syndrome, and two had the symptom of snoring without apnea. Four patients had a long history of alcohol abuse with fatty liver, but had no liver dysfunction. In these four patients, one had alcoholism for many times. One out of the five patients had no history of alcohol abuse, but said to have been treated by a traditional Chinese medical technique GUASHA. All the patients underwent resection surgery, during which a large amount of noncapsulated white adipose tissue was confronted. The duration of follow-up lasted from three months to two years. There was one case of recurrence one year after the surgery and the patient refused re-operation. No obvious recurrence was found in the rest of the group.　Conclusions　 Symmetric lipomatosis is a benign lesion characterized by diffused and symmetric accumulation of adipose tissue in the superficial or deep fascia space in the cervico-thoracic region. It mainly takes place in the middle-aged people. Long history of alcohol abuse and typical clinical manifestations can help to reach the diagnosis, but alcoholism may not be the only cause in etiology. Surgery may be the feasible therapeutic modality up to now.

引用本文： 李文,陳盡歡,辜德英,張紅英,張先強(qiáng). 頸部對稱性脂肪瘤的診治. 華西醫(yī)學(xué), 2011, 26(3): 368-371. doi: 復(fù)制

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1. 　陳興明, 李五一, 倪道鳳, 等. Madelung病的診斷和治療[J]. 中華耳鼻咽喉頭頸外科雜志, 2006, 41(7): 524-527.
2. 　Jaske R, Holzer H, Popper H. The “fat neck”. Symmetrical lipomatosis with Madelung Syndrome symptoms[J]. Laryngol Rhinol Otol(stuttg), l980, 59(11): 749-758.
3. 　Ujpal M, Nemeth ZS, Reichwein A, et al. Long-term results following surgical treatment of benign symmetric lipomatosis (BSL)[J]. Int J Oral M axillofac Surg, 2001, 30(6): 479-483.
4. 　González-García R, Rodríguez-Campo FJ, Sastre-Pérez J, et al. Benign symmetric lipomatosis (Madelung’s disease): case reports and current management[J]. Aesthetic Plast Surg, 2004, 28(2): 108-112.
5. 　Busetto L, Strater D, Enzi G, et al. Differential clinical expression of multiple symmetric lipomatosis in men and women[J]. Int J Obes Relat Metab Disord, 2003, 27(11): 1419-1422.
6. 　Parmar C, Blackburn C. Madelung’s disease: an uncomnon disorder of unknown aetiology[J]. Br J Oral Maxillofac Surg, 1996, 34(5): 467-470.
7. 　Enzi G, Busetto L, Ceschin E, et al. Multiple symmetric lipomatosis: clinical aspects and outcome in a long term longitudinal study[J]. Int J Obes Relat Metab Disord, 2002, 26(2): 253-261.
8. 　Grau MA. Gonzalez HF, Rieart EW. Multiple symmetrical lipomatosis and chronic alcoholism [J]. An Med Intern, 1989, 6(12): 635-638.
9. 　王學(xué)玖, 潘巨利, 李鈞, 等. 良性對稱性脂肪瘤病1例報告[J]. 北京口腔醫(yī)學(xué), 2008, 16(3): 168-169.
10. 　Shimada S, Ishizawa T, Ishizawa K, et al. The value of MDM2 and CDK4 amplification levels using real-time polymerase chain reaction for the differential diagnosis of liposarcomas and their histologic mimickers[J]. Hum Pathol, 2006, 37(9): 1123-1129.
11. 　莫立根, 許堅, 楊榮寧, 等. 良性對稱性脂肪瘤病28例報告[J]. 臨床耳鼻咽喉科雜志, 2002, 16(10): 537-538.
12. 　闞英南, 姚平, 辛偉紅, 等. 良性對稱性脂肪瘤病的診斷和治療(附6例報告)[J]. 臨床耳鼻咽喉頭頸外科雜志, 2010, 24(2): 105-107.
  1. 1. 　陳興明, 李五一, 倪道鳳, 等. Madelung病的診斷和治療[J]. 中華耳鼻咽喉頭頸外科雜志, 2006, 41(7): 524-527.
  2. 2. 　Jaske R, Holzer H, Popper H. The “fat neck”. Symmetrical lipomatosis with Madelung Syndrome symptoms[J]. Laryngol Rhinol Otol(stuttg), l980, 59(11): 749-758.
  3. 3. 　Ujpal M, Nemeth ZS, Reichwein A, et al. Long-term results following surgical treatment of benign symmetric lipomatosis (BSL)[J]. Int J Oral M axillofac Surg, 2001, 30(6): 479-483.
  4. 4. 　González-García R, Rodríguez-Campo FJ, Sastre-Pérez J, et al. Benign symmetric lipomatosis (Madelung’s disease): case reports and current management[J]. Aesthetic Plast Surg, 2004, 28(2): 108-112.
  5. 5. 　Busetto L, Strater D, Enzi G, et al. Differential clinical expression of multiple symmetric lipomatosis in men and women[J]. Int J Obes Relat Metab Disord, 2003, 27(11): 1419-1422.
  6. 6. 　Parmar C, Blackburn C. Madelung’s disease: an uncomnon disorder of unknown aetiology[J]. Br J Oral Maxillofac Surg, 1996, 34(5): 467-470.
  7. 7. 　Enzi G, Busetto L, Ceschin E, et al. Multiple symmetric lipomatosis: clinical aspects and outcome in a long term longitudinal study[J]. Int J Obes Relat Metab Disord, 2002, 26(2): 253-261.
  8. 8. 　Grau MA. Gonzalez HF, Rieart EW. Multiple symmetrical lipomatosis and chronic alcoholism [J]. An Med Intern, 1989, 6(12): 635-638.
  9. 9. 　王學(xué)玖, 潘巨利, 李鈞, 等. 良性對稱性脂肪瘤病1例報告[J]. 北京口腔醫(yī)學(xué), 2008, 16(3): 168-169.
  10. 10. 　Shimada S, Ishizawa T, Ishizawa K, et al. The value of MDM2 and CDK4 amplification levels using real-time polymerase chain reaction for the differential diagnosis of liposarcomas and their histologic mimickers[J]. Hum Pathol, 2006, 37(9): 1123-1129.
  11. 11. 　莫立根, 許堅, 楊榮寧, 等. 良性對稱性脂肪瘤病28例報告[J]. 臨床耳鼻咽喉科雜志, 2002, 16(10): 537-538.
  12. 12. 　闞英南, 姚平, 辛偉紅, 等. 良性對稱性脂肪瘤病的診斷和治療(附6例報告)[J]. 臨床耳鼻咽喉頭頸外科雜志, 2010, 24(2): 105-107.