腹腔鏡下に修復しえた成人Bochdalek孔ヘルニアの1例

A case of Bochdalek hernia treated by laparoscopic Dual Mesh repair

◆要旨：患者は22歳，男性．上腹部痛，嘔気を主訴に当院を受診した．胸部X線検査で左横隔膜の挙上と左肺野の胃内ガス像を，CTで左横隔膜にヘルニアを認め，左胸腔へ拡張した胃の脱出が認められた．以上より成人Bochdalek孔ヘルニアと診断し，腹腔鏡下に手術を施行した．脱出した臓器の腹腔内への還納とヘルニア門周囲の剝離およびメッシュを用いた修復術を行った．術後経過は良好であり，術後5日目に退院した．術後8か月を経過した現在，再発を認めていない．Bochdalek孔ヘルニアは新生児に発症し治療されることが多く，成人例は稀とされている．今回，Bochdalek孔ヘルニアに対し，メッシュを用いた腹腔鏡下修復術を施行し，良好な経過を辿った1例を経験したので報告する．

　An adult Bochdalek hernia is a rare clinical condition. A 22-year-old man visited our hospital, complaining of upper abdominal pain and nausea. A chest X-ray showed elevation of the left diaphragm and a gastrointestinal gas image in the left lowerthorax. Computed tomography （CT） showed incarceration of the stomach into the left lower thorax. The patient was diagnosed as having a Bochdalek hernia. He was treated by laparoscopic surgery. The hernia contents were reduced into the abdominal cavity, and the adhesions between the hernia hilus and the incarcerated organs were detached. Finally, the diaphragmatic defect was covered with a Dual Mesh. The patients was discharged on the 5 postoperative day without any complications. At 8 months after operation, the patient remained asymptomatic. Laparoscopic Dual Mesh repair is a safe and less-invasive treatment method for diaphragmatic hernia.