@article{oai:uoeh-u.repo.nii.ac.jp:00000809,
 author = {金山, 雅俊 and 井上, 政昭 and 吉田, 順一 and 田中, 文啓 and Kanayama, Masatoshi and Inoue, Masaaki and Yoshida, Junichi and Tanaka, Fumihiro},
 issue = {3},
 journal = {産業医科大学雑誌, Journal of UOEH},
 month = {Sep},
 note = {Situs inversus totalis is a rare clinical condition that represents a complete mirror image of the normal arrangement of the thoracic and abdominal viscera. There are very few reported cases of lung cancer patients with situs inversus totalis, but this condition requires particular care during surgery. A 61-year-old woman presented to our hospital with an abnormal shadow on chest radiography. Computed tomography revealed a 25×12 mm solitary pulmonary nodule in the left upper lobe (S2) and a complete mirror image of the normal organ arrangement, which findings met the criteria of situs inversus totalis. Preoperative examination revealed left upper lobe lung cancer (c-T1bN0M0 Stage IA), and surgery was planned for diagnosis and treatment. Before the surgery, three-dimensional CT images were reconstructed for a precise evaluation of the pulmonary vessels and bronchi. The nodule was microscopically diagnosed as adenocarcinoma from a frozen section obtained by wedge resection. We performed a left upper lobectomy with lymphnode dissection using video-assisted thoracic surgery. The aortic arch was absent from the left thoracic cavity and the left lung was well lobulated into three lobes. Although it revealed a mirror image of the usual arrangement, we could accomplished in the usual procedure and process. Careful preoperative anatomical evaluation and perioperative handling are essential for the prevention of intraoperative injuries and complications in patients with situs inversus totalis., 完全内臓逆位は，各臓器が左右逆転し正常位に対して鏡面像的位置関係にあるものをいい，頻度は10,000人に1～2人と稀にみられる常染色体劣性遺伝の破格である．今回，完全内臓逆位に合併した原発性肺癌に対して，胸腔鏡下手術を施行した報告をする．症例は61歳女性．胸部X線写真で左上肺野に異常陰影を指摘され紹介となる．胸腹部CTにて胸腹部内臓の完全逆位に加え，左肺上葉S2に葉間胸膜に接する25 × 12 mmの結節影を認めた．術前検査にて左上葉肺癌疑いc-T1bN0M0 Stage IAとして手術を行う方針とした．術前3D構築画像にて鏡面像を呈した肺動静脈および気管支の立体的構造を把握した．手術は腫瘍を胸腔鏡下に部分切除を行い，迅速病理検査で腺癌と診断されたため完全胸腔鏡下に左上葉切除およびリンパ節郭清を施行した．左縦隔に下行大動脈は認めず，左肺は上中下葉の3葉に分葉していた．左右鏡面像であったが，正常解剖の際の手技，手順で施行可能であった．完全内臓逆位の手術においては，つねに反対側の胸腔をイメージしながらの手術となる．そのため術前に肺血管，気管支の解剖学的評価を十分に行った上での慎重な手術操作が必要となる．},
 pages = {237--241},
 title = {完全内臓逆位に合併した肺癌に対する胸腔鏡下肺葉切除術},
 volume = {40},
 year = {2018}
}