Cui Beibei, Lei Sanlin, Liu Kuijie, Yao Hongliang
Department of Gastrointestinal Surgery, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan, 410011, People's Republic of China.
BMC Surg. 2018 Aug 20;18(1):64. doi: 10.1186/s12893-018-0394-3.
Situs inversus totalis (SIT) refers to an unusual condition involving reversal of abdominal and thoracic viscera, with an incidence rate of 1/5000-20,000 adults. Minimally invasive surgeries for SIT patients are technically challenging, while the surgical experience for SIT patients is quite limited.
A 61-year-old man, previously diagnosed as SIT, came to our hospital for 6 months history of hematochezia and altered bowel habit. A diagnosis of rectal cancer was made in view of colonoscopic biopsy which confirmed an irregular circumferential lump of well differentiated adenocarcinoma at 10 cm from the anal verge. The computed tomography contrast-enhanced (thorax + abdomen + pelvis) scan revealed a total transposition of abdominal and thoracic organs and an enhanced eccentric mass of rectal but with no evidence of distant metastasis. Robotic low anterior resection (LAR) plus transanal natural orifice specimen extraction (NOSE) was performed after obtaining informed consent. The procedure was performed successfully and the patient convalesced nicely without any complications. The postoperative pathological diagnosis revealed a 4x4x0.6 cm moderately differentiated adenocarcinoma and circumferential clearance.
Robotic LAR plus transanal NOSE for rectal cancer patients with SIT can be performed safely and may be an effective approach in contrast to open or laparoscopic approach, despite the unconventional anatomy.
全内脏反位（SIT）是一种罕见的情况，涉及腹部和胸部内脏的反转，在成年人中的发病率为1/5000 - 20000。为SIT患者进行微创手术在技术上具有挑战性，而且针对SIT患者的手术经验相当有限。
一名61岁男性，先前被诊断为SIT，因便血和排便习惯改变6个月前来我院就诊。鉴于结肠镜活检结果，诊断为直肠癌，活检证实距肛缘10 cm处有一个不规则的环形肿块，为高分化腺癌。计算机断层扫描增强（胸部 + 腹部 + 骨盆）扫描显示腹部和胸部器官完全转位，直肠有一个强化的偏心肿块，但无远处转移迹象。在获得知情同意后，实施了机器人辅助低位前切除术（LAR）加经肛门自然腔道标本取出术（NOSE）。手术顺利完成，患者恢复良好，无任何并发症。术后病理诊断显示为一个4x4x0.6 cm的中分化腺癌及环周切缘情况。
对于SIT直肠癌患者，机器人辅助LAR加经肛门NOSE手术可安全实施，尽管解剖结构不常规，但与开放或腹腔镜手术相比，可能是一种有效的手术方法。
