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患者男,58岁。因进食阻挡感半年,加重半月伴胸骨后疼痛、乏力、消瘦。食管钡餐诊断下段食管癌。食管拉网细胞学检查找到癌细胞。B超示全内脏反位,心脏位于右侧,肝脏位于左季肋部,脾脏位于右肋部。经右胸后外侧切口行食管癌切除、食管胃弓上吻合术。术中见右肺为两叶,主动脉弓及胸主动脉于脊椎右缘。食管下段可触及4cm长肿块,侵及肌层,与周围轻度粘连,肿块以上食管轻度扩张。打开右侧膈肌见腹腔脏器完全反位,处于相当正常位置。术后诊断:全内脏反位,下段食管癌。病理报告:鳞癌,髓质型。讨论:全内脏反位病人临床上较为少见,因胸腹腔脏器位置反转,在患某些疾病时易造成误诊,对需要手术者选择刀口位置时也应想到其特殊性。本例术前B超发现,手术证实,术后病理确诊。
Male patient, 58 years old. Due to eating sensation for half a year, aggravated half-monthly chest pain, fatigue, weight loss. Esophageal barium meal diagnosis of lower esophageal cancer. Esophageal pull cytology finds cancer cells. B ultrasound shows the visceral anti-position, the heart is on the right side, the liver is on the left quarter rib, and the spleen is on the right rib. Right esophagectomy and esophageal and gastric bowel anastomosis were performed on the right and left thoracotomy. See the right lung for the two leaves during surgery, the aortic arch and thoracic aorta to the right edge of the spine. The lower part of the esophagus can reach a 4cm long mass that invades the muscularis and has mild adhesions to the surrounding area. The esophagus above the mass expands slightly. When the right phrenic muscle is opened, the abdominal organs are completely reversed and are in a fairly normal position. Postoperative diagnosis: anti-visceral visceral, lower esophageal cancer. Pathology report: squamous cell carcinoma, medulla type. Discussion: Patients with visceral dislocation are clinically rare. Because the position of organs in the chest and abdomen is reversed, it is easy to cause misdiagnosis when suffering from certain diseases. The specificity should also be considered when the surgeon needs to select the position of the knife edge. This case was found by preoperative B-mode ultrasound, confirmed by surgery, and confirmed by postoperative pathology.