3．外傷性横隔膜損傷

Traumatic Diaphragmatic Injury

外傷性横隔膜損傷（traumatic diaphragmatic injury：TDI）は重症多発外傷の一損傷として発症することが多く，その頻度は胸部外傷に対する手術例の約1.2％とされる1）．TDIは全身状態を急激に重篤化させる危険性があるため，迅速な診断と治療が求められる．したがって，重症胸部外傷例を診察する場合には常に念頭におく必要がある．本稿では，TDIの分類，病態，診断，治療について解説する．

Traumatic diaphragmatic injury （TDI） is rare in traumas, however TDI is associated with high mortality. We follow the notation method by The Japanese Association for The Surgery of Trauma. There are blunt trauma and penetrating trauma of TDI；blunt trauma causes mainly traffic accidents, and penetrating trauma is induced stub or gunshot. Penetrating trauma is more frequent than blunt trauma in Western countries, however there are mainly blunt traumas in Japan. The timing of diagnosis are three points；acute phase, subacute phase and delayed phase. In acute phase we often experienced unstable vital sign, so the patients of TDI need treatment immediately, however in delayed phase the patients of TDI are stable in vital signs. In order to diagnose for TDI, we use chest X-ray and computed tomography （CT）, which is useful to diagnose by multi-planar reconstruction of multi-detector row CT. The ways to approach to TDI are from thoracotomy, laparotomy or both. When we repair the diaphragmatic injury, usually interrupted or horizontal mattress suture was applied with non-absorbable string. The mortality is about 8.8 to 19.8％ by TDI, so we need to carefully diagnose TDI as soon as possible whether complication and abdominal viscera injury exist or not.