胸腔鏡下にアプローチした外傷性肋間肺ヘルニア嵌頓の1例

Traumatic Intercostal Lung Hernia Repaired by Video-assisted Thoracoscopic Surgery；Report of a Case

はじめに　肋間ヘルニアは，肋骨周囲もしくは肋間筋の筋組織の間隙をヘルニア門として，胸腔内組織が骨性胸郭の外へ脱出する病態とされている1）．われわれは交通外傷後に生じた外傷性の肋間肺ヘルニア嵌頓に対し，胸腔鏡下に整復し治療することができた症例を経験したので報告する．

The 40-year-old male patient was raced to our hospital complaining respiratory difficulty after hitting his left chest at a handle when falling down from a bicycle. Fracture of 5th left rib and partial lung prolapsed intercostally out of the thorax was observed by computed tomography （CT）. Due to exacerbated pneumothorax and pneumoderma recognized 12 hours later by CT with the lung remained incarcerated, a surgery was conducted. Camera port was placed from 8th intercostal part at left midaxillary line. The left lung was partially incarcerated from ruptured intercostal part of fractured 5th rib. Adding a working port from 7th intercostal part at the posterior axillary line, the incarcerated lung was thoracoscopically reduced. The thoracoscopic surgery was completed by fixing the rib outside the thoracic wall with 2-0 nylon suture without partial resection of the lung. The patient was discharged on day 7 with satisfactory progress. Thoracoscopic approach is effective for traumatic intercostal lung hernia.