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全内脏转位患者行腹腔镜胆囊切除术——视频腹腔镜袖状胃切除术病例报告

Laparoscopic cholecystectomy in a patient with situs inversus totalis after videolaparoscopic sleeve-Case report.

作者信息

Ponce Leon Fernando, Fiorencio Mariana H, Leal Camilla P, Santos André R

机构信息

Department of Surgery, Federal University of Rio de Janeiro, Brazil.

Clementino Fraga Filho University Hospital (HUCFF - UFRJ), Brazil.

出版信息

Int J Surg Case Rep. 2020;71:202-204. doi: 10.1016/j.ijscr.2020.04.045. Epub 2020 May 19.

Abstract

INTRODUCTION

Situs inversus totalis is the technical term used when there is a complete transposition of all organs to the opposite side referring to classical embryogenic orientation. Laparoscopic cholecystectomy is one of the most performed surgeries in the world.

PRESENTATION OF CASE

We report the case of a 61-year-old female patient who had previously undergone videolaparoscopic gastroplasty 7 months ago, who developed refractary biliary colic and underwent videolaparoscopic cholecystectomy.

DISCUSSION

The surgical technique is challenging in these cases, specially because of the mirror findings in relation to the original technique. An additional challenge in this case was the fact that the patient had a previous laparoscopy due to gastroplasty performed. The presence of adhesions related to the surgery hardly interfered with the Calot triangle dissection, but the way they presented themselves required the attention of the entire surgical team.

CONCLUSION

Although uncommon, laparoscopic cholecystectomy can be performed in a situs inversus patient with ease, even in the presence of a previous surgical approach.

摘要

引言

全内脏反位是一个专业术语,指所有器官相对于经典胚胎发育方向完全转位至身体另一侧。腹腔镜胆囊切除术是世界上开展最为广泛的手术之一。

病例介绍

我们报告一例61岁女性患者,该患者7个月前曾接受电视腹腔镜胃成形术,现出现难治性胆绞痛并接受了电视腹腔镜胆囊切除术。

讨论

在这些病例中,手术技术具有挑战性,特别是因为与原始技术相比存在镜像表现。该病例的另一个挑战是患者此前因胃成形术接受过腹腔镜检查。与手术相关的粘连几乎未干扰胆囊三角的解剖,但粘连的表现方式需要整个手术团队予以关注。

结论

尽管罕见,但即使患者此前有手术史,腹腔镜胆囊切除术也可在全内脏反位患者中轻松实施。

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