Departments of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 1-South, 16-West, Chuo-ku, Sapporo 060-8543, Japan.
World J Surg Oncol. 2013 Dec 17;11:312. doi: 10.1186/1477-7819-11-312.
Situs inversus totalis (SIT) denotes complete right-left inversion of the thoracic and abdominal viscera. Diagnosis and surgical procedures for abdominal pathology in patients with SIT are technically more complicated because of mirror-image transposition of the visceral organs. Moreover, SIT is commonly associated with cardiovascular and hepatobiliary malformations, which make hepatobiliary-pancreatic surgery difficult. Two cases of pancreaticoduodenectomy for biliary tract carcinoma in patients with SIT are presented. Both patients had an anomaly of the hepatic artery. Advanced diagnostic imaging techniques were very important for careful preoperative planning and to prevent misunderstanding of the arrangement of the abdominal viscera. This facilitated the surgical team's adaptation to the mirror image of the standard procedure and helped avoid intraoperative complications due to cardiovascular and hepatobiliary malformations associated with SIT. Pancreaticoduodenectomy in patients with SIT can be performed successfully with detailed preoperative assessment, use of effective techniques by the surgeon, and appropriate support by assistants.
全内脏反位（SIT）表示胸腔和腹腔内脏完全左右反转。由于内脏器官的镜像移位，SIT 患者的腹部病理诊断和手术程序在技术上更为复杂。此外，SIT 通常与心血管和肝胆畸形有关，这使得肝胆胰手术变得困难。本文介绍了 2 例 SIT 患者行胰十二指肠切除术治疗胆道癌。这 2 例患者均存在肝动脉异常。先进的诊断成像技术对于仔细的术前规划非常重要，可防止对腹部内脏排列的误解。这有助于手术团队适应标准手术的镜像，并有助于避免因 SIT 相关的心血管和肝胆畸形引起的术中并发症。通过详细的术前评估、外科医生使用有效的技术以及助手的适当支持，可以成功地为 SIT 患者施行胰十二指肠切除术。
