胸部外傷に対する胸腔鏡下手術

Video-assisted Thoracoscopic Surgery for Chest Trauma

胸部外傷手術では緊急止血がもっとも重要であり，アプローチとしては開胸手術が基本となるが，近年，肺破裂などを認めず特にバイタルサインが安定した胸部外傷例では，損傷部位や範囲，損傷の程度の確認と胸腔内全体の観察のため，緊急手術においても胸腔鏡を使用することが一般的となっている．止血や損傷臓器修復のため開胸移行を余儀なくされることもあるが，当科では積極的に胸腔鏡を活用している．当科で経験した胸部外傷手術例に関して検討し，手術手技について報告する．

Video-assisted thoracoscopic surgery （VATS） is now commonly used in emergency surgery to confirm the site of injury and observe the thoracic cavity, especially in cases of chest trauma with stable vital signs. VATS was used in all 33 chest trauma surgeries performed at our department from October 2009 to July 2023. The common injury mechanisms were traffic trauma and falls, but there were also cases of trauma from a bullhorn, heavy machinery and farm equipment, and penetrating injury. The common surgical procedures were treatment of rib fractures and pulmonary suture or partial lung resection, followed by treatment of diaphragmatic injuries. Unusual surgical procedures included extrapleural hematoma drainage, pericardial drainage, hemostasis of intrathoracic bleeding from thoracic vertebral fracture, and lobectomy for airway bleeding. Here, we report our surgical policies and techniques for chest trauma. First, the thoracic cavity should be observed thoracoscopically to determine the site of injury. The key to repair is placement of a small thoracotomy directly above the rib fracture site, where dislocation is largest, followed by suture repair of the lung and diaphragm by combining direct and thoracoscopic views.