Adenosquamous Carcinoma of the Lung in a Patient with Complete Situs Inversus
Adenosquamous Carcinoma of the Lung in a Patient with Complete Situs Inversus
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DOI：
10.5761/atcs.cr.09.01521
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发表时间：
2011-04-01
影响因子：
1.3
通讯作者：
Minato, Hiroshi
中科院分区：
文献类型：
--
作者：
Shimizu, Junzo;Arano, Yoshihiko;Minato, Hiroshi
我们提出一个罕见的情况下，肺腺鳞癌的病人完全反位。患者为76岁女性，主诉为血痰。胸部X线和胸部计算机断层扫描（CT）显示器官和血管的镜像，并显示左下肺野直径3.5 cm的肿瘤。她被转诊至日本金泽KKR北陆医院接受手术。支气管镜检查显示支气管的正常排列呈镜像，左下支气管有5个节段性分支。手术期间，使用Univent插管时应小心。单肺通气支气管插管。在开胸手术中，左肺的大体外观以及肺血管和支气管的排列与正常情况下在右侧发现的一致。我们成功地进行了左下叶切除术。术后诊断证实为p-t4 n1 m0的腺鳞癌伴局限性胸膜播散，IIIa期。术前影像学检查，包括CT、支气管镜检查和血管造影检查，将有助于预防接受肺切除术的完全性原位反转患者在手术期间发生血管或支气管损伤。在对这些患者进行手术时，应始终考虑到可能的血管或支气管异常。
We present a rare case of adenosquamous carcinoma of the lung in a patient with complete situs inversus. The patient was a 76-year-old woman with the chief complaint of hemosputum. Chest X-ray and computed tomography (CT) scans of the thorax showed a mirror image of the organs and vessels and revealed a tumor 3.5 cm in diameter, in the left lower lung field. She was referred and admitted to KKR Hokuriku Hospital, Kanazawa, Japan to undergo surgery. Bronchoscopy showed a mirror image of the usual arrangement of the bronchi, and 5 segmental branches in the left lower bronchi. During surgery, care was exercised when intubation with the Univent. bronchial tube for one-lung ventilation. On thoracotomy, the gross appearance of the left lung and the arrangement of the pulmonary vessels and the bronchi corresponded to those normally found on the right side. We were successful in performing a left lower lobectomy. Postoperative diagnosis confirmed an adenosquamous carcinoma with localized pleural dissemination as p-t4n1m0, stage IIIa. Preoperative imaging, including CT, bronchoscopy, and angiographic examination of the patient, will be useful for prevention of vascular or bronchial injury during surgery in patients with complete situs inversus undergoing lung resection. Possible vascular or bronchial anomalies should always be taken into consideration while operating on these patients.