腹腔鏡下に修復した急性期外傷性横隔膜損傷の1例

A case of acute traumatic diaphragmatic injury repaired laparoscopically

◆要旨：患者は89歳，男性．交通外傷で受傷し，当院救急搬送となった．胸腹部造影CT検査で外傷性横隔膜損傷と診断され，同日緊急で腹腔鏡下手術を施行した．横隔膜損傷部より，胃・横行結腸が胸腔内へ脱出しており，これを還納し，損傷部を合成吸収性バーブ付き縫合糸で縫合閉鎖した．また，小腸穿孔を認め，縫合閉鎖した．術後24日目に気管切開し，術後78日目に転院，術後4年の胸部X線検査で再発はなかった．急性期外傷性横隔膜損傷に対する手術アプローチ法は様々だが，開腹手術の報告が多い．本症例は急性期症例に対して腹腔鏡下に修復した．当院で経験した他の5例と比較検討しながら報告する．

　An 89-year-old male sustained injuries due to a traffic accident and was transported to our hospital as an emergency case. Contrast-enhanced CT of the chest and abdomen revealed a traumatic diaphragmatic injury, and an emergency laparoscopic surgery was performed on the same day. The stomach and transverse colon had herniated into the thoracic cavity through the diaphragmatic defect. These organs were reduced back into the abdominal cavity, and the defect was closed using synthetic absorbable barbed sutures. Additionally, a small bowel perforation was identified and closed with sutures. A tracheostomy was performed on postoperative day 24, and the patient was transferred to another hospital on postoperative day 78. A chest X-ray taken four years after surgery showed no recurrence. Various surgical approaches have been reported for acute traumatic diaphragmatic injuries, with many cases involving laparotomy. In this case, the repair was successfully performed laparoscopically in the acute phase. This report discusses the case in comparison with five other cases experienced at our institution.