腹部臓器固定術を併施した胸腹併用鏡視下横隔膜弛緩症手術の1例

Diaphragmatic Eventration Treated with Abdominal Organ Fixation by a Combination of Thoracoscopy and Laparoscopy：Report of a Case

はじめに　横隔膜弛緩症の手術適応に関しては明確な基準が定められておらず，一般に無症状の場合は経過観察でよいとされている．有症状の場合は手術が考慮されるが，呼吸不全に対する呼吸機能改善を目的とするものが多い．われわれは横隔膜弛緩症に伴う上部消化器症状の改善を目的として胸腹併用鏡視下手術を行い，良好な経過を得たので報告する．

We report a case of diaphragmatic eventration treated by a combination of thoracoscopy and laparoscopy. A 49-year-old man was taken by ambulance to our hospital for emergency with a chief complaint of epigastric tightness and left-sided abdominal distention. A chest X-ray showed elevation of the left diaphragm, and diaphragmatic eventration was suspected, resulting in an initial visit to our department. A computed tomography （CT） of the thorax and abdomen showed that part of the liver, stomach, spleen, and colon splenic flexure were highly displaced cephalad, and the above symptoms were diagnosed as being caused by diaphragmatic eventration, and surgery was indicated because of the strong symptoms. The surgery was performed laparoscopically first because of the strong gastrointestinal symptoms and for safe thoracic manipulation, the stomach was suture-fixed to the diaphragmatic leg and the splenic flexure of the colon to the lateral abdomen. Next, thoracoscopic surgery was performed. The entire diaphragm was highly relaxed. The diaphragm was repaired first by resection with a stapler, followed by additional plication. The postoperative course was good, and the above symptoms disappeared completely.