BACKGROUND Situs inversus totalis(SIT)is a rare group of congenital developmental malformations in the clinical setting,with all organs in the chest and abdomen existing in a mirror image reversal of their normal posi...BACKGROUND Situs inversus totalis(SIT)is a rare group of congenital developmental malformations in the clinical setting,with all organs in the chest and abdomen existing in a mirror image reversal of their normal positions.Few reports have described laparoscopic surgery for colorectal cancer in patients with SIT,and it is considered difficult even for an experienced surgeon because of the mirror positioning.We present a case report of laparoscopic radical resection of a colonic splenic flexure carcinoma in a patient with SIT.CASE SUMMARY A 72-year-old male was referred to our hospital with colonic splenic flexure carcinoma,and computed tomography showed that all the organs in the chest and abdomen were inverted.Laparoscopic hemicolectomy with complete mesocolic excision was safely performed.The operating surgeon stood on the patient’s left side,which is opposite of the normal location.CONCLUSION Abdominal computed tomography is an effective method for diagnosing SIT preoperatively in patients with colonic splenic flexure carcinomas.Laparoscopic radical resection is difficult,but it is well established and safe.The surgeon should stand in the opposite position and perform backhand operations.展开更多
Volvuli affecting the distal colon, specifically the splenic flexure onwards is underdiagnosed pathologies with non-specific clinical features. Delay in diagnosing these pathologies can lead to significant morbidity a...Volvuli affecting the distal colon, specifically the splenic flexure onwards is underdiagnosed pathologies with non-specific clinical features. Delay in diagnosing these pathologies can lead to significant morbidity and mortality in terms of ischemia and perforation of bowel. Multi detector computed tomography (MDCT) with intravenous contrast is an accurate and reliable imaging modality allowing prompt diagnosis and management. We present an overview of the radiological features found in acute presentations of different types of colonic volvuli.展开更多
目的探讨“肠系膜下动脉优先解剖联合完全内侧入路”(priority anatomy of the inferior mesenteric artery combined with complete medial approach,IMA—CMA)结肠脾曲游离技术在腹腔镜左半结肠癌根治术中的应用效果。方法收集2016年...目的探讨“肠系膜下动脉优先解剖联合完全内侧入路”(priority anatomy of the inferior mesenteric artery combined with complete medial approach,IMA—CMA)结肠脾曲游离技术在腹腔镜左半结肠癌根治术中的应用效果。方法收集2016年7月至2021年12月由本团队实施腹腔镜左半结肠癌根治术的74例患者的临床资料进行回顾性分析,按照手术方式的不同,将患者分为传统入路(traditional approach,TA)组与IMA—CMA组,每组纳入患者例数分别为43例、31例。将两组患者的临床基线资料按照1∶1的比例进行倾向性评分匹配(propensity score matching,PSM),最终每组各纳入22例患者进行分析。记录两组术中情况(手术时间,术中出血量,脾出血事件,淋巴结清扫总数,253组淋巴结清扫数目)和术后恢复情况(术后住院时间,Clavien-DindoⅡ级及以上的术后并发症发生情况)。结果与TA组相比,IMA—CMA组的平均手术时间更短,中位术中出血量更少,253组淋巴结清扫数目更多,差异均有统计学意义(均P<0.05)。两组脾出血事件发生率、淋巴结清扫总数及术后住院时间比较差异均无统计学意义(均P>0.05)。TA组共发生Clavien-DindoⅡ级及以上的术后并发症2例,均为肠梗阻;IMA—CMA组共发生Clavien-DindoⅡ级及以上的术后并发症3例,包括肠梗阻1例、腹腔感染1例、肺栓塞1例。两组Clavien-DindoⅡ级及以上的术后并发症发生率及术后肠梗阻、腹腔感染、肺栓塞的发生率比较差异均无统计学意义(均P>0.05)。两组均无术后腹腔出血病例。结论“肠系膜下动脉优先解剖联合完全内侧入路”结肠脾曲游离技术安全可行,有助于缩短手术时间和减少术中出血量,有利于253组淋巴结充分清扫,且不增加围手术期并发症的发生率。展开更多
基金Supported by Chongqing medical scientific research project(Joint project of Chongqing Health Commission and Science and Technology Bureau),No.2021MSXM309.
文摘BACKGROUND Situs inversus totalis(SIT)is a rare group of congenital developmental malformations in the clinical setting,with all organs in the chest and abdomen existing in a mirror image reversal of their normal positions.Few reports have described laparoscopic surgery for colorectal cancer in patients with SIT,and it is considered difficult even for an experienced surgeon because of the mirror positioning.We present a case report of laparoscopic radical resection of a colonic splenic flexure carcinoma in a patient with SIT.CASE SUMMARY A 72-year-old male was referred to our hospital with colonic splenic flexure carcinoma,and computed tomography showed that all the organs in the chest and abdomen were inverted.Laparoscopic hemicolectomy with complete mesocolic excision was safely performed.The operating surgeon stood on the patient’s left side,which is opposite of the normal location.CONCLUSION Abdominal computed tomography is an effective method for diagnosing SIT preoperatively in patients with colonic splenic flexure carcinomas.Laparoscopic radical resection is difficult,but it is well established and safe.The surgeon should stand in the opposite position and perform backhand operations.
文摘Volvuli affecting the distal colon, specifically the splenic flexure onwards is underdiagnosed pathologies with non-specific clinical features. Delay in diagnosing these pathologies can lead to significant morbidity and mortality in terms of ischemia and perforation of bowel. Multi detector computed tomography (MDCT) with intravenous contrast is an accurate and reliable imaging modality allowing prompt diagnosis and management. We present an overview of the radiological features found in acute presentations of different types of colonic volvuli.
文摘目的探讨“肠系膜下动脉优先解剖联合完全内侧入路”(priority anatomy of the inferior mesenteric artery combined with complete medial approach,IMA—CMA)结肠脾曲游离技术在腹腔镜左半结肠癌根治术中的应用效果。方法收集2016年7月至2021年12月由本团队实施腹腔镜左半结肠癌根治术的74例患者的临床资料进行回顾性分析,按照手术方式的不同,将患者分为传统入路(traditional approach,TA)组与IMA—CMA组,每组纳入患者例数分别为43例、31例。将两组患者的临床基线资料按照1∶1的比例进行倾向性评分匹配(propensity score matching,PSM),最终每组各纳入22例患者进行分析。记录两组术中情况(手术时间,术中出血量,脾出血事件,淋巴结清扫总数,253组淋巴结清扫数目)和术后恢复情况(术后住院时间,Clavien-DindoⅡ级及以上的术后并发症发生情况)。结果与TA组相比,IMA—CMA组的平均手术时间更短,中位术中出血量更少,253组淋巴结清扫数目更多,差异均有统计学意义(均P<0.05)。两组脾出血事件发生率、淋巴结清扫总数及术后住院时间比较差异均无统计学意义(均P>0.05)。TA组共发生Clavien-DindoⅡ级及以上的术后并发症2例,均为肠梗阻;IMA—CMA组共发生Clavien-DindoⅡ级及以上的术后并发症3例,包括肠梗阻1例、腹腔感染1例、肺栓塞1例。两组Clavien-DindoⅡ级及以上的术后并发症发生率及术后肠梗阻、腹腔感染、肺栓塞的发生率比较差异均无统计学意义(均P>0.05)。两组均无术后腹腔出血病例。结论“肠系膜下动脉优先解剖联合完全内侧入路”结肠脾曲游离技术安全可行,有助于缩短手术时间和减少术中出血量,有利于253组淋巴结充分清扫,且不增加围手术期并发症的发生率。
