胸腔鏡・腹腔鏡併用の完全内視鏡下手術による成人Bochdalek孔ヘルニアの1例

A case of adult Bochdalek hernia treated completely by endoscopic surgery, with combining thoracoscopy with laparoscopy

◆要旨：患者は58歳，男性．健診異常で行った胸部CTで左横隔膜にヘルニアを認め，胸腔内へ大網の脱出を認めた．Bochdalek孔ヘルニアの診断で手術の方針となった．手術は腹腔鏡で行うこととしたが，胸腔内に嵌入した大網量が多く，胸腔鏡操作も行えるように準備した．まず，腹腔鏡下で大網の還納を試みたが，胸腔内への大網の癒着が懸念され，胸腔鏡下手術を追加した．ヘルニア門は腹腔鏡下にて縫合閉鎖し，メッシュも併用した．術後経過は良好であり，術後5日目に退院となった．成人Bochdalek孔ヘルニアに対する完全内視鏡下手術の報告は少なく，胸腔鏡・腹腔鏡を併用することでより安全で確実かつ低侵襲な手術を施行できたため，若干の文献的考察を加えて報告する．

A 58-year-old man had an abnormal X-ray on physical examination and underwent a chest CT. He was diagnosed with a Bochdalek hernia and laparoscopic surgery was planned. There was a large amount of omentum in the thoracic cavity, which we attempted to return to the abdominal cavity laparoscopically. However, we were concerned about adhesions of the omentum in the thoracic cavity, so we decided to combine thoracoscopic surgery. We sutured the hernia orifice and covered it with a mesh. The patient was discharged on the fifth postoperative day. Few reports on adult Bochdalek hernia have appeared. Combined thoracoscopy and laparoscopy proved to be both safe and minimally invasive. We also review the relevant literature.