緊急腹腔鏡下手術で修復した外傷性横隔膜破裂の1例

Laparoscopic repair of traumatic diaphragmatic rupture : a case report

◆要旨：患者は70歳，女性．シートベルト着用下での正面衝突事故後，当院にドクターヘリで救急搬送された．来院時，前胸部痛と軽度の呼吸困難を認め，CTにて左外傷性横隔膜破裂と診断し緊急腹腔鏡下手術を施行した．腹腔鏡下観察において他臓器損傷は認めず，左三角間膜やや腹側の腱中心付近で横隔膜腱性部が横方向に5cm裂けており，同部位より胃・大網が左胸腔内に脱出していた．脱出臓器を腹腔内に還納し，横隔膜破裂部を2-0vicryl^TMで結節縫合し修復した．術後8日目，合併症なく軽快退院した．

The patient was a 70-year old female. Following a frontal impact accident while wearing a seat belt, she was airlifted by helicopter ambulance to our hospital. At the time of admission, pain in the precordial region and mild dyspnea were observed. Rupture of the diaphragm due to a left-side external injury was diagnosed by CT and an emergency laparoscopic operation was performed. In the laparoscopic observation, there were no injuries to other organs, but in the vicinity centered around the left triangular ligament and the tendon slightly toward the stomach, the tendinous portion of the diaphragm was ruptured 5 cm in the horizontal direction, and from there, the stomach protruded into the left chest cavity. The exposed viscera were reduced internally, and the rupture of the diaphragm was repaired with a 2-0 vicryl^TM knotted suture. On the 8th day after surgery, there were no complications and the patient was discharged without problems.