遅発性外傷性左横隔膜ヘルニアに対して腹腔鏡下ヘルニア修復術を施行した1例

Laparoscopic repair of traumatic left diaphragmatic hernia with delayed onset : A case report

◆要旨：患者は80歳，男性．交通外傷8か月後に転院先で酸素化低下を認めたため紹介となった．左横隔膜ヘルニアへの胃と横行結腸の嵌頓と診断し，緊急で腹腔鏡下横隔膜ヘルニア修復術を施行した．胃と横行結腸を腹腔内へ整復後，門は非吸収糸による結節縫合とステープラーを用いて閉鎖し，メッシュで補強した．術後に胸腔ドレーンを留置して陰圧管理を行い，合併症なく転院した．外傷性横隔膜ヘルニアに対する腹腔鏡下アプローチで完遂するための工夫とメッシュ留置の有用性について若干の文献的考察を加えて報告する．

An 80-year-old man presented with hypoxia. Eight months previously, he had suffered a traffic accident. A computed tomography showed strangulation of the stomach and the transverse colon through a left diaphragmatic hernia. Laparoscopic surgery was urgently performed ; the strangulated stomach and transverse colon were pulled back to the abdominal cavity, the hernia gate was closed by direct suture and stapler, and reinforced with surgical mesh. After the surgery, the left thoracic cavity was kept with negative pressure through a thoracostomy tube. The patient recovered without any postoperative complications. We aim to describe our surgical technique in detail and to review the literature about laparoscopic repair of traumatic diaphragmatic hernia.