全内脏反位胆总管癌1例

Common bile duct adenocarcinoma in a patient with situs inversus totalis:a case report

目的探讨全内脏反位与胆总管癌的关系,了解全内脏反位胆总管癌的诊断和手术中的注意事项。方法回顾分析2016年12月收治的1例全内脏反位胆总管癌诊疗情况,并复习文献探讨全内脏反位与胆总管癌的关系,总结全内脏反位胆总管癌的诊断以及手术中的注意事项。结果该例经腹部CT(平扫+增强)诊断为全内脏反位并胆总管癌,行胆囊切除+胆总管肿物切除+肝总管空肠Roux-en-Y吻合术,手术顺利,无术中及术后并发症。术后1月入肿瘤科化疗,2017年4月5日随访病人恢复良好。结论全内脏反位与胆总管癌的形成没有确切关系。术前行腹部CT(平扫+增强)有利于疾病诊断,同时便于判断肿瘤切除的可行性。精细的手术技巧和术前评估可以提高手术成功率并减少术后并发症。

Objective To discuss the relationship between stitus inversus totails and common bile duct cancer and understand the diagnosis and Surgical considerations of common bile duct adenocarcinoma in a patient with situs inversus totalis.Methods The diagnosis and Surgical considerations of common bile duct adenocarcinoma in a patient with situs inversus totalis treated in December 2016 were summarized by Analyzing our case and reviewing the literature,and the relationship between stitus inversus totails and common bile duct cancer was discussed.Result Cholecystectomy,common bile duct tumor resection and Roux-en-Y hepaticojejunostomy were performed in the patient with situs inversus totalis diagnosed by CT(plain CT scan and contrast enhancemen),then chemotherapy was performed in the patient who has no special discomfort now(April 5,2017).Conclusions There is no definite relationship between the situs inversus totalis and the formation of common bile duct cancer.The location and size of tumor,adjacent relationship between tumor and surrounding tissue and feasibility of tumor resection were benefited from the examination of CT(plain CT scan and contrast enhancement).Fine surgical techniques and preoperative assessment can improve the success rate of surgery and reduce postoperative complications.