胸腔鏡下修復手術が有用であった左外傷性横隔膜ヘルニアの1例

Left traumatic diaphragmatic rupture repaired by video-assisted thoracic surgery : a case report

症例は65歳，女性．乗用車を運転中に他車と衝突し，左胸腹部痛と左肩痛を訴え救急車で搬送された．受傷時にシートベルトは着用しており，エアバックも作動した．胸腹部，左肩に外傷はなく独歩は可能であった．胸部X線検査で左横隔膜の不鮮明化と，左胸腔内の胃泡を認めた．CT検査では左横隔膜中央が欠損し，同部から胃穹窿部が胸腔内へ突出していた．左外傷性横隔膜ヘルニアと診断した．胸腔内および腹腔内臓器の損傷はなく，全身状態は安定していたため，受傷2日後に胸腔鏡下に修復術を行った．左横隔膜のドーム頂部から心横隔膜角にかけて3cm大の破裂孔を認めた．体外結紮法で6針で縫合閉鎖した．術後経過は良好で術後15病日に退院した．

　A case of left traumatic diaphragmatic rupture repaired by video-assisted thoracic surgery was experienced. A 65-year-old female was admitted to our hospital due to left thoracic and abdominal pain and left shoulder pain in after traffic accident. Chest X-ray and CT scan revealed a left-sided diaphragmatic rupture with herniation of the stomach into the left thoracic cavity. No other hemorrhagic and perforative complications were detected.

　Two days after the admission, video-assisted thoracic surgery was performed. The left diaphragm was found to be ruptured for about 3 cm in length. The rupture site was sutured with 6 extra-corporeal knots by nonabsorbable suture. The postoperative course was uneventful, and the patient was discharged 15 days later.