診断的胸腔鏡が有用であった鈍的外傷による横隔膜損傷の1例

Diaphragmatic Injury Due to Blunt Trauma Diagnosed by a Diagnostic Thoracoscopy；Report of a Case

はじめに　本邦では胸部外傷はほとんどが鈍的外傷であり，手術適応になる頻度が低いために診断的胸腔鏡を行うということはあまりない．一方，欧米では鋭的外傷が多く，横隔膜損傷の診断，治療を目的に胸腹部外傷に診断的胸腔鏡を実施することがめずらしくない．われわれは，血胸に対する緊急止血手術の適応はないものの，画像所見より横隔膜損傷を疑い診断的胸腔鏡により横隔膜損傷を診断した鈍的外傷の1例を経験したので報告する．

We performed an exploratory thoracoscopy for a suspected diaphragm injury caused by a blunt-force chest trauma.

A male patient in his fifties involved in a traffic accident and was transported by ambulance to our hospital. Upon arrival, his vital signs were stable, however, he was diagnosed as having fractures of the right tibia and fibula, multiple rib fractures and a slight right hemothorax. The limb fracture was treated by emergency surgery and the chest trauma was managed by chest drainage. Since injury of the diaphragm by fragment of the right 10th rib was suspected with chest computed tomography （CT）, an exploratory thoracoscopy was performed after orthopedic surgery, and a laceration of the diaphragm without herniation was successfully closed.