完全内臓逆位の胸部食道癌患者に対して胸腔鏡下食道切除術を施行した1例

Thoracoscopic esophagectomy for thoracic esophageal cancer with situs inversus totalis : Report of a case

◆要旨：患者は62歳，女性．以前から完全内臓逆位と診断されていた．嚥下障害を主訴に精査を行い，胸部食道癌，cT3, cN0, cM0, cStageⅡ（食道癌取扱い規約第11版）と診断された．術前化学療法施行後に胸腔鏡下食道切除術と胃管再建術を施行した．事前に動画反転ソフトを用いて正常解剖の手術動画を左右反転することで完全内臓逆位患者に対する胸腔鏡下手術イメージを得たうえで手術に臨んだ．術中偶発症はなく，術後左気胸を発症したがドレナージで軽快し，術後17日目に退院した．完全内臓逆位患者に対する胸腔鏡下食道切除術は，左右鏡面像となる解剖学的位置を事前に十分に把握していれば安全に施行できる術式と考えられた．

　Situs inversus totalis is a congenital abnormality characterized by a complete transposition of thoracic and abdominal organs. Here we report on a rare case of successful thoracoscopic esophagectomy for thoracic esophageal cancer with situs inversus totalis. A 62-year-old woman with situs inversus totalis underwent an upper gastrointestinal endoscopy to investigate the cause of dysphagia, which revealed a tumor of the middle-third of the esophagus. The tumor was diagnosed by biopsy as squamous cell carcinoma of the esophagus （clinical T3N0M0, StageⅡ）. We performed neoadjuvant chemotherapy followed by thoracoscopic esophagectomy with gastric pull-up reconstruction. The patient had an uneventful postoperative course except left-sided pneumothorax. Preoperative image training using horizontally-flipped video of our previous operation helped us perform a safe and quick thoracoscopic surgery.