左外傷性横隔膜ヘルニアに対する胸腔鏡下手術の経験

Thorcoscopic Surgery for Left Traumatic Diaphragmatic Hernia: A Case Report

　患者は48歳，女性．交通事故で当院の救急外来に搬送され，左第8,9,10助骨骨折および第12胸椎圧迫伸延損傷の診断で当院の整形外科に入院した．入院2日目に左胸腔ドレナージ後の胸部X線で左外傷性横隔膜ヘルニアと診断し，入院4日目に胸腔鏡下手術を施行した。脱出臓器は大網，横行結腸，肝臓，脾臓であった．横隔膜損傷部の修復には，ループ針とsuture clipの併用が有用であった．循環動態が安定していて，消化管損傷・腹腔内実質臓器損傷が否定できる場合には，経胸的アプローチが有利であると考えられた．

A 48-year-old woman was transferred to our hospital due to multiple injuries caused by traffic accident, and was admitted to the orthopedics with the diagnosis of multiple left lateral rib fractures and flexion-distraction injurues of the thoracic vertebra. Two days after the admission, the chest X-ray revealed left traumatic dia-phragmatic hernia. Four days after the admission, thoracoscopic repair of left traumatic diaphragmatic hernia was performed. A part of the greater omentum, the transeverse colon, the lateral lobe of the liver and the spleen were found in the thoracic cavity.