刺傷による横隔膜損傷の修復術における胸腹腔鏡観察の有用性

Significance of Thoraco-laparoscopic Observation in Repairing Diaphragmatic Injury by the Penetrating Trauma

胸腹部外傷において横隔膜損傷を伴うものは2.1％とまれであるが1），胸腔内と腹腔内の貫通性損傷では，圧較差を原因とした腹腔内臓器の脱出などにより重症化のおそれがある．また肋間動脈や腸間膜，腹腔内管腔臓器などの損傷は，初期診療時に見落とされてしまい重篤な状態に陥ることがある．われわれは，受傷時の画像所見で横隔膜損傷を確認し，胸腹腔双方からの鏡視下観察により手術を行った症例を経験したので報告する．

A 53-year-old man with a penetrating trauma was admitted to our hospital. Thoracoabdominal computed tomography （CT） on admission showed left diaphragmatic injury and peritoneal fat in the left thoracic cavity. Under a diagnosis of the traumatic diaphragmatic injury, an emergency operation was performed, and the left diaphragm was repaired. No other injuries were found in the thoracic and abdominal organs by thoraco-laparoscopic observation. The postoperative course was uneventful, and the patient left hospital on the 14th day after surgery. In case of the diaphragm injury, it is important to confirm the probable injuries of other organs by thoraco-laparoscopic observation.