胸腔鏡・腹腔鏡下に救命処置を行った胸腹部多発刺創の1例

Thoraco-laparoscopic surgery for multiple stab wounds to the chest and abdomen

◆要旨：患者は43歳の女性で不眠・抑うつの既往があった．血まみれの状態で倒れているところを発見され当院に救急搬送された．包丁での自傷による多発刺創で，CTで頸部皮下気腫・上縦郭血腫，左血気胸，腹腔内血腫を認め，左胸腔には血管外漏出像を伴っており，緊急手術を行った．多量の血腫，縦隔と肺舌区の損傷，左内胸動脈からの拍動性の出血を認め，止血操作を行った後に舌区の損傷部をステイプラーで切除した．肝臓に多発刺創を認め一部は貫通していたが，いずれも止血しており胆汁漏も認めなかった．術後経過は良好で術後4日目に精神科に転科となった．胸腔鏡・腹腔鏡による観察および治療は詳細な観察ができ低侵襲であり，有用であると考えられた．

　The patient was a 43-year-old woman with a history of insomnia and depression. She was found on the floor covered in blood, and she was transported to our hospital. She had stabbed herself multiple times with a kitchen knife. Computed tomography showed subcutaneous emphysema of the neck, a superior mediastinal hematoma, left hemopneumothorax, and an intra-abdominal hematoma. Extravasation into the left side of the thoracic cavity was also present, and emergency surgery was performed. Voluminous hematomas, damage to the mediastinum and lingula of the left lung, and pulsatile bleeding from the left internal thoracic artery were noted. Once hemostasis was achieved, the damaged portion of the lingula was resected with a stapler. Multiple stab wounds to the liver were noted; some had perforated the liver. Bleeding from all of these wounds was stopped, and no bile leakage was noted. The patient's postoperative course was satisfactory, and on day 4 postoperatively, she was transferred to the Department of Psychiatry. Thoracoscopy and laparoscopy allow detailed observation of the thoracic and abdominal cavities. Thoracoscopic and laparoscopic surgery is useful and minimally invasive.