開心術後縦隔炎に対し腹腔鏡下に大網充塡を施行した1例

Laparoscopic harvest and filling of an omental flap for infected mediastinal wound reconstruction : a case report

◆要旨：患者は73歳，男性．胸骨正中切開アプローチにて冠動脈バイパス術を施行したが，術後約1週間で縦隔炎を発症したため，創部の開放および持続陰圧閉鎖療法（VAC）を行った．VACにて滲出液の減少を認めたため，有茎大網を用いた縦隔再建術を行った．腹腔鏡下に十分な量の大網を採取し，横隔膜を通して挙上し創部全体に充塡した．大網の血行を確認した後，創を閉鎖した．術後経過は良好で，第15病日に軽快退院した．開腹下での大網採取は開心術後の患者にとって侵襲が大きく，整容性を損ね，心肺機能回復に支障をきたす場合もある．今回，腹腔鏡下に大網を採取することで上腹部切開を回避し，良好な経過を得たので報告する．

　A 73-year-old man was suffering from an infected sternotomy dehiscence following coronary artery bypass grafting. Aggressive medical therapy, debridement of the infected wound and vacuum assisted closure （VAC） resolved purulent effusion. At this point, we decided to perform the reconstructive surgical procedures. We performed laparoscopic harvest of an omental flap and used it to fill the sternal defect through a small diaphragm incision while confirming its viability. The omental flap was fixed to the sternal wound and the skin was closed as usual. The postoperative course was uneventful and the patient was discharged on POD 15. Transposition of the greater omentum has traditionally required an open laparotomy with significant laparotomy-related morbidity. Laparoscopic surgery may be an effective alternative for the treatment of infected mediastinal wounds with decreasing the physiological stress after open heart surgery.