腹腔镜远端胃切除术治疗全内脏反位合并胃恶性肿瘤及胃肠间质瘤
Laparoscopic Distal Gastrectomy for Synchronous Gastric Cancer and Gastrointestinal Stromal Tumor With Situs Inversus Totalis.
机构信息
Department of Surgery, Kochi Medical School, Kochi, Japan;
Department of Surgery, Kochi Medical School, Kochi, Japan.
出版信息
In Vivo. 2021 Mar-Apr;35(2):913-918. doi: 10.21873/invivo.12331.
Abstract
BACKGROUND
Situs inversus totalis (SIT) is a rare congenital condition in which the thoracic and abdominal organs are inverted like a mirror image.
CASE REPORT
We present a case of synchronous gastric cancer and gastrointestinal stromal tumor (GIST) associated with SIT in a 74-year-old man who was admitted to our department to treat gastric cancer. Esophagogastroduodenoscopy revealed a depressed lesion and a submucosal tumor (SMT) in the middle-third of the stomach. Abdominal contrast-enhanced computed tomography revealed complete inversion of the internal organs, and the common hepatic artery branched from the superior mesenteric artery. The patient underwent laparoscopic distal gastrectomy with regional lymph node dissection and Billroth I reconstruction. The macroscopic observation of the resected specimen revealed a depressed lesion measuring 2.0×1.5 cm in diameter and an SMT measuring 2.2×1.8 cm.
CONCLUSION
Careful preoperative anatomic evaluation is important in SIT because the situs anomalies may be accompanied by major vascular anomalies.
摘要
背景
全内脏反位（SIT）是一种罕见的先天性疾病，其特点是胸腔和腹腔器官呈镜像反转。
病例报告
我们报告了一例 74 岁男性 SIT 合并胃恶性肿瘤和胃肠道间质瘤（GIST）的病例，该患者因胃恶性肿瘤就诊于我科。胃镜检查发现胃中三分之一处有一凹陷性病变和黏膜下肿瘤（SMT）。腹部增强 CT 显示内脏完全反转，肝总动脉发自肠系膜上动脉。患者接受了腹腔镜下远端胃切除术和区域淋巴结清扫术以及 Billroth I 重建术。切除标本的大体观察显示直径为 2.0×1.5cm 的凹陷性病变和直径为 2.2×1.8cm 的 SMT。
结论
SIT 术前需要仔细进行解剖学评估，因为内脏位置异常可能伴有大血管异常。
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