Shimizu Junzo, Arano Yoshihiko, Adachi Iwao, Morishita Minoru, Fuwa Bungo, Saitoh Motoyasu, Minato Hiroshi
Departments of Surgery, KKR Hokuriku Hospital, Kanazawa, Ishikawa, Japan.
Ann Thorac Cardiovasc Surg. 2011;17(2):178-81. doi: 10.5761/atcs.cr.09.01521.
We present a rare case of adenosquamous carcinoma of the lung in a patient with complete situs inversus. The patient was a 76-year-old woman with the chief complaint of hemosputum. Chest X-ray and computed tomography (CT) scans of the thorax showed a mirror image of the organs and vessels and revealed a tumor 3.5 cm in diameter, in the left lower lung field. She was referred and admitted to KKR Hokuriku Hospital, Kanazawa, Japan to undergo surgery. Bronchoscopy showed a mirror image of the usual arrangement of the bronchi, and 5 segmental branches in the left lower bronchi. During surgery, care was exercised when intubation with the Univent bronchial tube for one-lung ventilation. On thoracotomy, the gross appearance of the left lung and the arrangement of the pulmonary vessels and the bronchi corresponded to those normally found on the right side. We were successful in performing a left lower lobectomy. Postoperative diagnosis confirmed an adenosquamous carcinoma with localized pleural dissemination as p-t4n1m0, stage IIIa. Preoperative imaging, including CT, bronchoscopy, and angiographic examination of the patient, will be useful for prevention of vascular or bronchial injury during surgery in patients with complete situs inversus undergoing lung resection. Possible vascular or bronchial anomalies should always be taken into consideration while operating on these patients.
我们报告一例全内脏反位患者发生肺腺鳞癌的罕见病例。患者为一名76岁女性，主诉为咯血。胸部X线和胸部计算机断层扫描（CT）显示器官和血管呈镜像，左肺下野有一个直径3.5 cm的肿瘤。她被转诊至日本金泽的KKR北陆医院接受手术。支气管镜检查显示支气管的正常排列呈镜像，左肺下叶有5个节段性分支。手术过程中，使用Univent支气管导管进行单肺通气插管时格外小心。开胸手术时，左肺的大体外观以及肺血管和支气管的排列与正常右侧的情况一致。我们成功实施了左下叶切除术。术后诊断证实为腺鳞癌伴局限性胸膜播散，p-t4n1m0，Ⅲa期。对全内脏反位患者进行肺切除手术时，术前的影像学检查，包括CT、支气管镜检查和血管造影检查，将有助于预防手术过程中的血管或支气管损伤。在对这些患者进行手术时，应始终考虑到可能存在的血管或支气管异常情况。
