全内脏反位胆总管癌1例
|
摘要
目的探讨全内脏反位与胆总管癌的关系,了解全内脏反位胆总管癌的诊断和手术中的注意事项。方法回顾分析2016年12月收治的1例全内脏反位胆总管癌诊疗情况,并复习文献探讨全内脏反位与胆总管癌的关系,总结全内脏反位胆总管癌的诊断以及手术中的注意事项。结果该例经腹部CT(平扫+增强)诊断为全内脏反位并胆总管癌,行胆囊切除+胆总管肿物切除+肝总管空肠Roux-en-Y吻合术,手术顺利,无术中及术后并发症。术后1月入肿瘤科化疗,2017年4月5日随访病人恢复良好。结论全内脏反位与胆总管癌的形成没有确切关系。术前行腹部CT(平扫+增强)有利于疾病诊断,同时便于判断肿瘤切除的可行性。精细的手术技巧和术前评估可以提高手术成功率并减少术后并发症。
Objective To discuss the relationship between stitus inversus totails and common bile duct cancer and understand the diagnosis and Surgical considerations of common bile duct adenocarcinoma in a patient with situs inversus totalis. Methods The diagnosis and Surgical considerations of common bile duct adenocarcinoma in a patient with situs inversus totalis treated in December 2016 were summarized by Analyzing our case and reviewing the literature, and the relationship between stitus inversus totails and common bile duct cancer was discussed.Result Cholecystectomy, common bile duct tumor resection and Roux-en-Y hepaticojejunostomy were performed in the patient with situs inversus totalis diagnosed by CT(plain CT scan and contrast enhancemen),then chemotherapy was performed in the patient who has no special discomfort now(April 5,2017). Conclusions There is no definite relationship between the situs inversus totalis and the formation of common bile dut cancer.The location and size of tumor,adjacent relationship between tumor and surrounding tissue and feasibility of tumor resection were benefited from the examination of CT(plain CT scan and contrast enhancement).Fine surgical techniques and preoperative assessment can improve the success rate of surgery and reduce postoperative complications.
Objective To discuss the relationship between stitus inversus totails and common bile duct cancer and understand the diagnosis and Surgical considerations of common bile duct adenocarcinoma in a patient with situs inversus totalis. Methods The diagnosis and Surgical considerations of common bile duct adenocarcinoma in a patient with situs inversus totalis treated in December 2016 were summarized by Analyzing our case and reviewing the literature, and the relationship between stitus inversus totails and common bile duct cancer was discussed.Result Cholecystectomy, common bile duct tumor resection and Roux-en-Y hepaticojejunostomy were performed in the patient with situs inversus totalis diagnosed by CT(plain CT scan and contrast enhancemen),then chemotherapy was performed in the patient who has no special discomfort now(April 5,2017). Conclusions There is no definite relationship between the situs inversus totalis and the formation of common bile dut cancer.The location and size of tumor,adjacent relationship between tumor and surrounding tissue and feasibility of tumor resection were benefited from the examination of CT(plain CT scan and contrast enhancement).Fine surgical techniques and preoperative assessment can improve the success rate of surgery and reduce postoperative complications.
引文
[1]BENHAMMANE H,KHARMOUM S,TERRAZ S,et al.Common bile duct adenocarcinoma in a patient with situs inversus totalis:report of a rare case[J].BMC Res Notes,2012,5:681.
[2]TOGLIANI T,PILATI S,MANTOVANI N,et al.Extrahepatic cholangiocarcinoma in a patient with situs inversus totalis diagnosed by endoscopic ultrasound[J].Endoscopy,2013,45 Suppl 2UCTN:E229-E230.DOI:10.1055/s-0033-1344327.
[3]魏兰义,秦新飞.新建医院1例全内脏反位胆总管癌根治术患者的护理体会[J].医学美学美容(中旬刊),2015(3):455-456.
[4]PERLES Z,CINNAMON Y,TA-SHMA A,et al.A human laterality disorder associated with recessive CCDC11 mutation[J].J Med Genet,2012,49(6):386-390.
[5]刘建平,史丽民,郑海燕,等.内脏反位合并胃癌2例[J].承德医学院学报,2011,28(1):95-96.
[6]方佳峰,魏波,郑宗珩,等.腹腔镜手术治疗全内脏转位低位直肠癌[J].中华胃肠外科杂志,2014,17(8):830-831.
[7]杨先芬,陈西兰,周启超,等.全内脏反位合并胰头癌一例[J].肝胆胰外科杂志,2016,28(4):342-342.
[8]齐浩龙,王义涛,郭涛,等.“镜面人”肝门部大肝癌一例[J].临床外科杂志,2014,18(5):337.
[9]张泽.经内镜逆行胆道支架置入术与经皮肝穿刺胆道支架置入术对肝门胆管癌的临床疗效分析[J].安徽医药,2016,20(1):133-134.
[10]BAGANTE F,GANI F,SPOLVERATO G,et al.Inrahepic Cholangiocarcinoma:Prognosis of Patients Who Did Not Undergo Lymphadenectomy[J].Journal of the American College of Surgens,2015,221(6):1031-1040.
[11]赵德胜,黄昆,韩继光.联合肝叶切除术治疗肝门部胆管癌29例疗效观察[J].安徽医药,2014,18(9):1746-1747.
[12]BRIDGEWATER J,GALLE PR,KHAN SA,et al.Guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma[J].J Hepatol,2014,60(6):1268-1289.
[13]ORGAN BC,SKANDALAKIS LJ,GRAY SW,et al.Cancer of bile duct with situs inversus[J].Arch Surg,1991,126(9):1150-1153.
[2]TOGLIANI T,PILATI S,MANTOVANI N,et al.Extrahepatic cholangiocarcinoma in a patient with situs inversus totalis diagnosed by endoscopic ultrasound[J].Endoscopy,2013,45 Suppl 2UCTN:E229-E230.DOI:10.1055/s-0033-1344327.
[3]魏兰义,秦新飞.新建医院1例全内脏反位胆总管癌根治术患者的护理体会[J].医学美学美容(中旬刊),2015(3):455-456.
[4]PERLES Z,CINNAMON Y,TA-SHMA A,et al.A human laterality disorder associated with recessive CCDC11 mutation[J].J Med Genet,2012,49(6):386-390.
[5]刘建平,史丽民,郑海燕,等.内脏反位合并胃癌2例[J].承德医学院学报,2011,28(1):95-96.
[6]方佳峰,魏波,郑宗珩,等.腹腔镜手术治疗全内脏转位低位直肠癌[J].中华胃肠外科杂志,2014,17(8):830-831.
[7]杨先芬,陈西兰,周启超,等.全内脏反位合并胰头癌一例[J].肝胆胰外科杂志,2016,28(4):342-342.
[8]齐浩龙,王义涛,郭涛,等.“镜面人”肝门部大肝癌一例[J].临床外科杂志,2014,18(5):337.
[9]张泽.经内镜逆行胆道支架置入术与经皮肝穿刺胆道支架置入术对肝门胆管癌的临床疗效分析[J].安徽医药,2016,20(1):133-134.
[10]BAGANTE F,GANI F,SPOLVERATO G,et al.Inrahepic Cholangiocarcinoma:Prognosis of Patients Who Did Not Undergo Lymphadenectomy[J].Journal of the American College of Surgens,2015,221(6):1031-1040.
[11]赵德胜,黄昆,韩继光.联合肝叶切除术治疗肝门部胆管癌29例疗效观察[J].安徽医药,2014,18(9):1746-1747.
[12]BRIDGEWATER J,GALLE PR,KHAN SA,et al.Guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma[J].J Hepatol,2014,60(6):1268-1289.
[13]ORGAN BC,SKANDALAKIS LJ,GRAY SW,et al.Cancer of bile duct with situs inversus[J].Arch Surg,1991,126(9):1150-1153.