胸腔鏡下骨片摘出を行った皮下気腫を伴う外傷性肋骨骨折の1例

Thoracoscopic resection of bone fragments for traumatic rib fractures

　患者は78歳，男性で右側胸部を打撲し，第4,5肋骨骨折および右側胸部の広範囲に皮下気腫を認めた．胸部単純および3D-CTにて非常に薄い骨片が？離したような形で骨折し，胸腔側へ向いて嵌入している所見を得た．呼吸苦の増悪を認めたため，胸腔鏡による手術療法を選択した．肋骨骨片の刺入部位と思われる胸壁に肺が癒着しており胸壁からぶら下がっていた．癒着を鈍的に？離すると胸膜を破り胸腔内に突出した骨片を2か所認め，2つの骨片を胸腔鏡下に周囲の胸膜を凝固切開しながら摘出した．術後経過は良好で，皮下気腫も消失し術後8日目に軽快し退院となった．胸部鈍的外傷に対して胸腔鏡下手術は有用な治療法の1つになりうると思われた．

A 78-year-old man was admitted to the hospital because of the bruise on the right chest that caused fourth and fifth right rib fractures with pervasive subcutaneous emphysema. Plain and three-dimensional computed tomography showed that the very thin fragments of the ribs had flaked off and had turned into thoracic cavity. Thoracoscopic surgery was performed because of the deterioration of the symptom. Operative finding revealed that the lung had adhered to the wall of the thoracic cavity which seemed to be the entry wound.