全内脏反位合并胃癌患者行腹腔镜远端胃癌根治术1例

Laparoscopic Distal Gastrectomy for Gastric Cancer in a Patient with Situs Inversus Totalis: A Case Report

摘要: 目的：探讨全内脏反位(Situs Inversus Totalis, SIT)合并胃癌患者行腹腔镜胃癌根治术的安全性、有效性、手术策略及围手术期管理经验。方法：回顾性分析山东第一医科大学第一附属医院2023年收治的1例SIT合并胃癌患者的临床资料，结合相关文献，总结该类特殊病例的腹腔镜手术操作规范。结果：患者术前经胸、腹、盆部增强CT扫描及胃镜病理确诊，影像学评估提示全内脏反位，肿瘤位于胃窦部。手术采用常规站位行腹腔镜下远端胃切除术，术中未发生腹腔脏器损伤、血管破裂等严重并发症。术后病理证实为胃窦中分化管状腺癌，切缘阴性，淋巴结转移(3/25)，病理分期pT2N1bM0。患者术后恢复顺利，无吻合口瘘、肠梗阻等并发症，于术后第9天出院。结论：SIT合并胃癌患者行腹腔镜胃癌根治术是安全、可行的。围绕镜像解剖特点开展充分术前评估、合理术中规划及针对性围手术期管理，可能有助于降低手术风险并促进术后恢复。

Abstract: Objective: To investigate the safety, efficacy, surgical strategy and perioperative management experience of laparoscopic radical gastrectomy in patients with gastric cancer complicated by situs inversus totalis (SIT). Methods: The clinical data of one patient with situs inversus totalis (SIT) complicated by gastric cancer admitted to the First Affiliated Hospital of Shandong First Medical University in 2023 was retrospectively analyzed. Combined with relevant literature, the standardized laparoscopic surgical procedures for such special cases were summarized. Results: The patient was preoperatively diagnosed by enhanced chest, abdominal and pelvic computed tomography (CT) scanning and gastroscopy with pathological examination. Imaging evaluation confirmed situs inversus totalis, and the tumor was located in the gastric antrum. Laparoscopic distal gastrectomy was performed with conventional patient positioning. No severe complications such as abdominal organ injury or vascular rupture occurred during the operation. Postoperative pathology confirmed moderately differentiated tubular adenocarcinoma of the gastric antrum with negative resection margins, lymph node metastasis (3/25), and pathological stage pT2N1bM0. The patient recovered smoothly after surgery without complications such as anastomotic leakage or intestinal obstruction, and was discharged on postoperative day 9. Conclusion: Laparoscopic radical gastrectomy is safe and feasible in patients with gastric cancer complicated by situs inversus totalis. Adequate preoperative assessment, proper intraoperative planning, and targeted perioperative management based on mirror-image anatomy may help reduce surgical risk and promote postoperative recovery.