医原性横隔膜ヘルニアに対して腹腔鏡下修復術を施行した1例

Iatrogenic diaphragmatic hernia after thoracic surgery treated by laparoscopic approach : A case report

◆要旨：患者は53歳，男性．当院呼吸器外科にて左上葉肺腺癌に対して胸腔鏡下左舌区区域切除術＋S8合併切除術を施行した．術中所見で胸腔内に強固な癒着を認め，癒着剝離時に横隔膜を損傷し，自動縫合器を用いて損傷部を縫合閉鎖した．術後5日目に左季肋部痛の増悪と食事摂取困難を認め，胸腹部CT検査にて左横隔膜をヘルニア門とした左胸腔内への胃と大網の脱出を認め，横隔膜ヘルニアと診断した．術後7日目に腹腔鏡下左横隔膜ヘルニア修復術を施行した．腹腔鏡操作にて経横隔膜的に癒着剝離を行い，ヘルニア門を縫合閉鎖した後，横隔膜欠損部に対してsymbotex^TM compositeメッシュを用いて被覆し，安全に手術施行可能であった．

　A 53-year-old man underwent thoracoscopic left upper lobectomy with S8 partial resection for lung cancer. The patient had epigastric pain five days after surgery. Chest X-ray and abdominal computed tomography scan revealed herniation of the stomach and greater omentum into the left thoracic cavity, and an iatrogenic diaphragmatic hernia was diagnosed. Laparoscopic repair of the hernia was performed. The incarcerated stomach and greater omentum were identified at the hernia orifice. After freeing of adhesions and reducing the contents into the abdomen, the hernia orifice was closed with sutures and the hiatus was repaired with disk-shaped mesh. Laparoscopic repair of diaphragmatic hernia was safely performed with good clinical outcome.