腹腔镜前入路右半肝切除治疗全内脏反位伴巨块型肝细胞癌1例报告并文献复习

One case report of laparoscopic right hemihepatectomy for situs inversus totalis with massive hepatocellular carcinoma and literature review

目的报道1例全内脏反位伴巨块型肝细胞癌患者的诊疗经过及疗效,并复习文献总结其临床特点和诊治手段,重点探讨手术方法的要点。方法患者男性,76岁,因“上腹部疼痛1月余”于入院,入院诊断为右肝巨块型肝癌合并全内脏反位。患者吲哚氰绿15分钟储留率(indocyanine green retention rate at 15 minute,ICG R15)为9.6%。CT提示肝右叶肿块,最大径12.8 cm,伴门静脉右支癌栓。肝脏虚拟成像测算肝脏总体积(total liver volume,TLV)约1727 cm3,肝肿瘤体积(tumor volume,TV)约380 cm3,剩余肝体积为(remnant liver volume,RLV)489 cm3;标准化肝体积(standard liver volume,SLV)1344 cm3,有效肝体积约36.4%。结果完善术前准备后在全麻下行腹腔镜前入路右半肝切除术。Trocar共5个,位置偏左,主刀站位于患者两腿之间。手术顺利,出血约300 mL,手术时间约300 min,术后14 d患者恢复良好出院,3周后开始靶向治疗。结论腹腔镜手术切除对于全内脏反位患者的巨块型肝癌是安全可行的,但术前须精确评估,全面掌握解剖结构的变异。手术时需调整Trocar位置,布局整体偏左,主操作孔与常规右半肝切除Trocar孔定位相反。前入路肝切除更有利于全内脏反位患者右半肝切除术的解剖游离。

Objective To report a patient with situs inversus totalis(SIT)combined with massive hepatocellular carcinoma,and review the literature.Methods The patient,a 76 year old male,was admitted due to upper abdominal pain for over a month.The diagnosis was SIT combined with massive hepatocellular carcinoma.The indocyanine green retention rate at 15 minutes(ICG R15)was 9.6%.CT showed a mass in the right lobe of the liver,with a maximum diameter of 12.8cm,accompanied by a tumor thrombus in the right branch of the portal vein.The virtual imaging of the liver was used to calculate the total liver volume(TLV)of 1727 cm3,the tumor volume(TV)of 380 cm3,the remnant liver volume(RLV)of 489 cm3.The standardized liver volume(SLV)was 1344 cm3,accounting for approximately 36.4%of the effective liver volume.Results After improving preoperative preparation,laparoscopic anterior approach right hemihepatectomy was performed under general anesthesia.There were 5 Trocars in total,located to the left.The surgery was successful,with approximately 300 mL of bleeding and a duration of 300 min.The patient recovered well and was discharged 14 days after surgery.Conclusions Laparoscopic resection is safe and feasible for SIT patients with massive liver cancer,but precise preoperative evaluation is necessary to fully grasp the variations in anatomical structure.During surgery,the Trocar position needs to be adjusted,with the overall layout leaning to the left,and the main operating hole positioned opposite to the conventional right hemihepatectomy Trocar hole.Anterior approach liver resection is more conducive to anatomical dissection of the right hemihepatec-tomy in the SIT patients.