腹腔镜手术治疗全内脏转位合并低位直肠癌1例及文献分析

One case of laparoscopic surgery for rectal cancer in patient with situs inversus totalis and its literature analysis

目的观察腹腔镜手术治疗全内脏转位合并直肠癌的疗效。方法回顾性分析2016年9月安徽医科大学第一附属医院胃肠外科收治的1例低位直肠癌合并全内脏转位并行腹腔镜手术治疗的患者临床资料,同时通过查阅复习相关文献,探讨其疗效及安全性。结果患者经检查提示全内脏转位合并直肠癌,行手术治疗,术后随访1年,患者均未出现相关并发症或肿瘤复发。经检索,全球报道的全内脏转位合并直肠癌患者15例,均接受手术治疗:其中6例为开放,7例腹腔镜,2例机器人。报道内容1例为手术录像,2例为护理体会,12例手术报道:其中1例为姑息性手术,14例为根治性手术,术后住院时间3~21d,15例患者均未发生手术并发症。结论内脏转位可根据影像学检查明确诊断,腹腔镜下全内脏转位低位直肠癌手术安全有效,内脏转位一般不需处理,但术前明确诊断可减少其手术风险。

Objective To observe the efficacy of laparoscopic surgery for reCTal cancer in patient with situs inversus totalis. Methods One case of laparoscopic surgery treated reCTal cancer combined with situs inversus totali was retrospeCTively analyzed in The First Affiliated Hospital of Anhui Medical University in September 2016,and the efficacy and safety of laparoscopic surgery in patients with reCTal cancer and situs inversus totails were discussed through reviewing related literatures. Results The patient was diagnosed as situs inversus totalis with reCTal cancer from medical examination,followed by surgery treatment,postoperative follow-up for one year,the patient did not appear obvious complications or recurrence of tumor. Additionally,15 cases of all situs inversus totalis with reCTal cancer were researched in the databases. Among them,6 cases with open surgery,4 cases with laparoscopic surgery and 2 cases with robotic surgery.The report includes 1 case of operation video,2 cases nursing experience and 12 cases of surgical reported,among them,1 case of palliative surgery and 14 cases of radical surgery. And the postoperative hospitalization time was about 3 to 21 days,and 15 patients had no complications in follow-up. Conclusions Situs inversus totalis can be diagnosed according to imaging examination. Applying laparoscopic surgery in patients with low reCTal cancer and situs inversus totalis is safe and effeCTive. The situs inversus totalis generally no need to be treated,but the preoperative accurate assessment can reduce the risk of surgery.