横隔膜弛緩症に対する完全胸腔鏡下での安全な縫縮の工夫

Plication for Diaphragmatic Eventration by Complete Video-assisted Thoracoscopic

横隔膜弛緩症は成人ではまれな疾患で，症状を認めない場合は保存的に経過をみるが，有症状の場合は手術適応となる1～4）．呼吸困難が出現した横隔膜弛緩症に対して胸腔鏡下に手術を行い，横隔膜に小孔を開けて腹腔内を観察し，横隔膜を安全に縫縮できた症例を経験したので，文献的考察を加えて報告する．

A 61-year-old woman was admitted to our hospital with progressive dyspnea on exertion. Chest X-rays and computed tomography （CT） showed elevation of the left diaphragm and atelectasis of the left lung. Eventration of the diaphragm was performed. The redundant diaphragm was plicated with vertical mattress sutures and reinforced by the suturing of the remnant diaphragm to the diaphragm near to the chest wall. During the thoracoscopic procedures, thoracoscopic examination from a small part of the resected diaphragm was conducted simultaneously to ensure safety and avoid damage to intra-abdominal organs. After plication, dyspnea on exertion was resolved and the patient was discharged on the 9th post-operative day.