Chiu Bo-Ya, Chuang Shu-Hung, Chuang Shih-Chang, Kuo Kung-Kai
School of Post-baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
World J Clin Cases. 2023 Mar 26;11(9):1939-1950. doi: 10.12998/wjcc.v11.i9.1939.
Situs inversus (SI) is a rare congenital condition characterized by a mirror-image transposition of the major visceral organs. Since the 1990s, more than one hundred SI patients have been reported to have successfully undergone laparoscopic cholecystectomy. In these cases, the major problem is to overcome is the left-right condition for right-handed surgeons. Laparoscopic common bile duct exploration (LCBDE), an alternative to treat patients with bile duct stones, has shown equivalent efficacy and is less likely to cause pancreatitis than endoscopic retrograde cholangiopancreatography. Recent updated meta-analyses revealed that a shorter postoperative hospital stay, fewer procedural interventions, cost-effectiveness, a higher stone clearance rate, and fewer perioperative complications are additional advantages of LCBDE. However, the technique is technically demanding, even for skilled laparoscopic surgeons. Conducting LCBDE in patients with difficult situations, such as SI, is more complex than usual. We herein review published SI patients with choledocholithiasis treated by LCBDE, including our own experience, and this paper focuses on the technical aspects.
内脏反位（SI）是一种罕见的先天性疾病，其特征是主要内脏器官呈镜像转位。自20世纪90年代以来，已有一百多例SI患者成功接受了腹腔镜胆囊切除术。在这些病例中，主要问题是克服对于右手操作的外科医生而言的左右方位问题。腹腔镜胆总管探查术（LCBDE）是治疗胆管结石患者的一种替代方法，已显示出同等疗效，且与内镜逆行胰胆管造影相比，引发胰腺炎的可能性更小。最近更新的荟萃分析表明，术后住院时间更短、手术干预更少、成本效益高、结石清除率更高以及围手术期并发症更少是LCBDE的其他优势。然而，即使对于熟练的腹腔镜外科医生来说，该技术在技术上也要求很高。在诸如SI等困难情况下的患者中进行LCBDE比通常情况更为复杂。我们在此回顾已发表的经LCBDE治疗的患有胆总管结石的SI患者，包括我们自己的经验，本文重点关注技术方面。
