Eisenberg Dan
Department of Surgery, Palo Alto VA Health Care System and Stanford School of Medicine, Palo Alto, CA, USA.
Int Med Case Rep J. 2009 Oct 28;2:27-9. doi: 10.2147/imcrj.s7702. Print 2009.
To report and describe a safe approach to laparoscopic cholecystectomy in patients with situs inversus totalis.
We present the case of a 61-year-old male who was diagnosed with gallstones and situs inversus totalis during work-up for epigastric pain. Laparoscopic cholecystectomy was performed in mirror-image to the standard approach, with the surgeon standing on the patient's right side. In order to maintain orientation and safety during the operation, anatomical structures were spatially related to each other in a "medial" and "lateral" manner, which are preserved in situs inversus; rather than "left" and "right" which are reversed.
The duration of the operation was 85 minutes, which is slightly longer than our standard laparoscopic cholecystectomy. Nonetheless, the patient was discharged on the morning following surgery, which is comparable to other patients undergoing laparoscopic cholecystectomy. He was seen in follow-up on postoperative day 14 and was doing very well. There were no postoperative complications.
Laparoscopic cholecystectomy can be performed safely in patients with situs inversus totalis. Careful attention to unfamiliar anatomic relationships is important. Approaching the anatomy in terms of medial and lateral structures, a relationship that is preserved, is helpful to complete the procedure safely.
报告并描述一种针对全内脏转位患者进行腹腔镜胆囊切除术的安全方法。
我们呈现了一名61岁男性患者的病例，该患者在因上腹部疼痛进行检查时被诊断出患有胆结石和全内脏转位。腹腔镜胆囊切除术以与标准方法镜像的方式进行，外科医生站在患者右侧。为了在手术过程中保持方向感和安全性，解剖结构以“内侧”和“外侧”的方式相互关联，这在全内脏转位中得以保留；而非以反转的“左”和“右”来定位。
手术时长为85分钟，略长于我们的标准腹腔镜胆囊切除术。尽管如此，患者在术后次日早晨出院，这与其他接受腹腔镜胆囊切除术的患者情况相当。术后第14天进行随访时，他恢复得很好。无术后并发症。
全内脏转位患者可安全地进行腹腔镜胆囊切除术。仔细留意不熟悉的解剖关系很重要。从内侧和外侧结构的角度来处理解剖关系，这种保留的关系有助于安全地完成手术。
