Chen Tao, Que Yu-Tao, Zhang Yi-Hao, Long Fei-Yu, Li Yi, Huang Xin, Wang Ya-Nan, Hu Yan-Feng, Yu Jiang, Li Guo-Xin
Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
World J Clin Cases. 2020 Feb 26;8(4):806-814. doi: 10.12998/wjcc.v8.i4.806.
Situs inversus totalis (SIT) is a rare congenital anomaly that refers to a completely reversed location of abdominal and thoracic organs. An extremely small number of patients with this condition, especially those with rectal neoplasms, have been reported. Surgery in these patients is technically challenging. Therefore, we reconstructed a three-dimensional (3D) digital model with the Materialise's interactive medical image control system (Mimics) as a guide for laparoscopic resection.
We report the case of a 68-year-old woman with rectal neoplasms and SIT diagnosed by electronic colonoscopy biopsy and enhanced computed tomography (CT), which showed that there was a soft tissue mass protruding into the lumen in the lower rectal segment, a lesion that involved the serosal layer, multiple enlarged peripheral lymph nodes, and visceral situs abnormalities. Based on the CT images, we reconstructed a 3D model with Mimics to assist with our surgical planning. Then, we performed laparoscopy-assisted radical resection of the rectal neoplasms and total excision of the lesion. Adjuvant chemotherapy with the XELOX regimen (oxaliplatin 150 mg, D1 + Xeloda 1.0 g, Bid, D1-14) was initiated 1 mo after the operation. The patient recovered well after surgery, and her physical condition remained stable.
Preoperative 3D reconstruction of the imaging results could help reduce the unknown risks during surgery caused by anatomical abnormalities and improve the perioperative safety for patients.
全内脏反位(SIT)是一种罕见的先天性异常,指的是腹部和胸部器官的位置完全颠倒。据报道,患有这种疾病的患者极少,尤其是那些患有直肠肿瘤的患者。这些患者的手术在技术上具有挑战性。因此,我们使用Materialise的交互式医学图像控制系统(Mimics)重建了三维(3D)数字模型,作为腹腔镜切除的指导。
我们报告了一例68岁患有直肠肿瘤和SIT的女性病例,该病例经电子结肠镜活检和增强计算机断层扫描(CT)诊断,结果显示直肠下段有一软组织肿块突入肠腔,病变累及浆膜层,多个外周淋巴结肿大,以及内脏位置异常。基于CT图像,我们使用Mimics重建了一个3D模型以辅助手术规划。然后,我们进行了腹腔镜辅助下直肠肿瘤根治性切除术及病变全切除术。术后1个月开始采用XELOX方案(奥沙利铂150 mg,第1天 + 希罗达1.0 g,每日2次,第1 - 14天)进行辅助化疗。患者术后恢复良好,身体状况保持稳定。
术前对影像学结果进行3D重建有助于降低因解剖异常导致的手术中未知风险,并提高患者围手术期的安全性。