完全性胸腹腔内脏反位合并十二指肠壶腹周围癌一例报告与文献复习

Periampullary carcinoma with situs inversus totalis：case report and review of the literature

目的总结完全性胸腹腔内脏反位合并十二指肠壶腹周围癌的临床诊治方法。方法报道2006年3月收治的1例极为罕见的完全性胸腹腔内脏反位合并十二指肠壶腹周围癌行胰十二指肠切除术的病例，并复习国内外相关文献。结果本例患者病理诊断为十二指肠乳头及壶腹部腺癌Ⅰ-Ⅱ级。术后1周胆红素降至正常：但2周后出现胃．空肠吻合输出袢粘连性不完全性梗阻，经内镜下置管、鼻饲、营养支持、针灸等处理，40d后痊愈出院。经检索，全球自1936-2006年间报道的全胸腹腔内脏反位合并恶性肿瘤的患者仅15例；其中只有5例全胸腹腔内脏反位合并胰头与壶腹周围癌的报道。结论完全性胸腹腔内脏反位合并肿瘤时，若无明显禁忌证，应同样予以积极的外科治疗，术中操作应注意完全相反的解剖学结构。

Objective To explore the diagnosis and surgical treatment of patients with periampuUary carcinoma and situs inversus totalis. Methods The data of a patient with periampuUary carcinoma and complete situs inversus totalis, a rare disease treated in our hospital on Mar. 2006, was reported, and relative articles were reviewed. Results This patient was diagnosed with stage Ⅰ to Ⅱ of periampullary carcinoma.Bilirubin was recovered one week postoperatively.Incomplete adhesive ileus at gastroenteral anastomosis appeared 2 weeks after the operation and was healed by nutritional support,acupuncture,endoscopic drainage and enteral nutrition. From 1936 to 2006, 15 malignant tumors with situs viscerum inversus totalis were reported, only 5 periampuUary carcinomas with situs viscerum inversus totalis were reported. Conclusions Surgical operation should be considered for malignant tumor patients with situs inversus totalis without contraindication. Attention should be paid to the opposite anatomical structure in this kind of situation.