完全内脏转位合并肠道肿瘤的诊断与治疗并文献复习

Diagnosis,treatment and literature review of situs inversus totalis combined with intestinal neoplasms

目的探讨完全内脏转位(SIT)合并肠道肿瘤患者的诊断与治疗。方法回顾性分析1例胸腹腔内脏完全转位合并结肠癌患者的临床表现和诊治过程,并检索2007至2017年的文献进行复习。结果患者临床表现为腹胀、贫血,胸腹部CT示:除心尖指向右以外,胸腹部组织器官完全反转;CT示肿瘤位于左侧,诊断为盲肠-升结肠癌;胃镜示胃转位。患者在全麻下行结肠癌根治术,术后病理示结肠腺癌。结论 SIT患者由于腹腔器官转位,常出现位置相反的症状表现,常易导致误诊,应尽可能完善所有相关检查明确诊断及指导手术的顺利开展;诊断及治疗均应遵循"反向思维"的原则。此外,合并消化道肿瘤的SIT患者并非腹腔镜技术及机器人技术的手术禁忌,手术效果同样安全有效。

Objective To investigate the diagnosis and treatment of situs inversus totalis(SIT)combined with intestinal neoplasms.Methods The clinical manifestations,diagnosis,and treatment of 1 patient with thoracic-abdominal visceral complete transposition and colorectal cancer was analyzed,and the literatures retrieved from 2007 to 2017 were reviewed.Results The clinical manifestations of the patient were abdominal distension and anemia.The chest and abdomen CT showed:the cardiac apex pointing forward to the right,the thoracic-abdominal tissues and organs completely reversed.Tumor was on the left side and was diagnosed as cecum and ascending colon cancer.Gastroscope showed gastric translocation.The patient underwent radical resection of colon cancer under general anesthesia,postoperative pathology showed colonic adenocar-cinoma.Conclusions Due to abdominal organ transposition,SIT patients often present opposite symptoms so that misdiagnosis is frequent.It should be as much as possible to complete all relevant tests to confirm the diagnosis and guide operation of the surgery.Diagnosis and treatment should follow the“reverse thinking”principle.In addition,SIT patients combined with digestive tract tumors are not contraindications for laparoscopic and robot surgery,the operation result is also safe and effective.