胸腔鏡・腹腔鏡併用下に修復した遅発性外傷性横隔膜ヘルニアの1例

A case of traumatic diaphragmatic hernia of delayed onset repaired by thoracoscopy and laparoscopy

◆要旨：症例は70代，男性．自宅階段で転倒して左肋骨を骨折し，経過観察となった．2か月後に胸部X線で異常影を指摘され，当科を紹介受診した．CTで左横隔膜の非連続性と胃穹窿部の脱出を認め，遅発性外傷性左横隔膜ヘルニアの診断で胸腔鏡・腹腔鏡併用手術を施行した．胸腔鏡操作の際には腹部から挿入した鉗子による補助を併用した．双方向から癒着剝離を行い，胸腔鏡下に人工気胸の圧を利用し，臓器を還納した．横隔膜の欠損部を胸腔側から1号非吸収糸で連続縫合し修復した．横隔膜ヘルニアに対して胸腔鏡・腹腔鏡併用手術および人工気胸の付加が有用であったため，文献的考察を含めて報告する．

　A man in his 70s fell down the stairs at home and suffered a left rib fracture. He visited our department two months later because of a chest X-ray abnormality. Computed tomography（CT）revealed discontinuity of the left diaphragm and prolapse of the gastric fornix. Surgery was performed with the diagnosis of a late left traumatic diaphragmatic hernia. Thoracoscopic and laparoscopic adhesiolysis was performed. The incarcerated stomach was repositioned to the abdominal cavity thoracoscopically with the pressure of artificial pneumothorax and the help of forceps inserted from the abdominal cavity. The hernia orifice was closed by a direct suture. In the present case, artificial pneumothorax combined with laparoscopic and thoracoscopic techniques was effective in the repair of traumatic diaphragmatic hernia.