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Background : Hepatectomy in a patient with situs inversus patient is technically challenging because of its complete mirror image anatomy, especially for a tumor located deep in the liver. Incorrectly... identifying intrahepatic vessels and biliary system would lead to serious complications. We experienced a hepatectomy for a tumor in a patient with situs inversus totalis with referring to computer-generated mirror images. Methods : A 66-year-old female patient with situs inversus totalis was diagnosed with hepatocellular carcinoma, 5 cm in diameter, centrally located just above the hepatic hilum compressing the right and left hepatic duct. The liver infected with hepatitis C was cirrhotic with a moderate amount of ascites. We preoperatively created several diagrams of the mirror image anatomy and made plans for how to resect this tumor, presupposing the patient had an ordinary anatomy. The tumor was successfully enucleated with referring to these diagrams. Results : The operation time was 454 minutes. Five units of fresh frozen plasma was transfused intraoperatively. Although she suffered refractory ascites which needed repeated paracentesis, she managed to leave the hospital two months after the operation. Conclusion : Creating a mirror image anatomy enables surgeons to safely perform a complex hepatectomy in a patient with situs inversus totalis.
【背景】完全内臓逆位患者に対する肝切除は，通常解剖とは完全に鏡面の解剖となるため，特に腫瘍が肝臓の深部に存在する場合には技術的に困難である．肝内脈管や胆道系の誤認は重篤な合併症に繋がる恐れがある．今回我々は完全内臓逆位患者に対する肝切除を，コンピュータで作成した鏡面像を利用しながら行った1例を経験したので報告する．【方法】症例は66 歳女性で，C 型肝炎の経過観察中，肝門部直上の深部に存在する，左右肝管を圧迫する5cm の肝細胞癌を指摘された．肝臓は中等量の腹水を伴う肝硬変で，肝移植を提示したが拒否され，切除を強く希望した．術前に複数の鏡面画像をコンピュータで作成し，通常解剖と仮定した上での手術計画を立てた．この鏡面画像を参照しながら腫瘍を核出した．【結果】手術時間は454 分で，術中5 単位の新鮮凍結血漿を輸血した．術後は難治性腹水を合併し，腹水穿刺を必要としたが，術後2 か月で自宅退院した．【結語】完全内臓逆位患者に対する肝切除を行う際，鏡面画像を作成することは，日ごろ親しんでいる通常解剖で手術計画を立てることができ，複雑な肝切除もより安全に手術を行うことが可能となる．続きを見る
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