腹腔鏡下に修復し得た胸部大動脈解離術後に生じた横隔膜ヘルニアの1例

A case of diaphragmatic hernia after thoracic surgery treated via the laparoscopic approach

◆要旨：患者は66歳，男性．2年前に大動脈解離に対して上行大動脈人工血管置換術，解離性大動脈瘤に対して下行大動脈人工血管置換術施行．突然の腹部膨満感・嘔気を主訴として当院を受診した．胸腹部CT検査で左胸腔内への胃の脱出を認めた．術後横隔膜ヘルニアと診断し，腹腔鏡下ヘルニア修復術を施行した．ヘルニア内容である胃穹窿部に虚血のないことを確認し，癒着を剝離して還納した．ヘルニア門を縫合閉鎖し，メッシュで補強した．大きな合併症なく術後9日目に退院した．医原性横隔膜ヘルニアは比較的稀な疾患である．横隔膜ヘルニアに対し，操作しやすい視野を確保しつつ，嵌頓した臓器の血流の評価およびヘルニアの修復を低侵襲に行えるため，腹腔鏡下手術は有用な可能性がある．

　A 66-year-old man with complaints of abdominal bloating and nausea presented to our hospital. Two years ago, the patient had undergone descending aortic graft replacement for aortic dissection. Radiography and computed tomography revealed a diaphragmatic hernia with prolapse of the stomach. Laparoscopic repair of the hernia was performed. Part of the stomach and greater omentum were inserted at the hernia orifice. Reduction of the herniated organ into the abdominal cavity was performed, and the hernia orifice was repaired with a mesh after closure via suturing. Iatrogenic diaphragmatic hernia is a relatively rare disease. Laparoscopic surgery is useful for diaphragmatic hernia because it is minimally invasive and enables simultaneous evaluation of the viability of incarcerated organ and repair of the hernia orifice.