腹腔鏡下に一期的両側横隔膜縫縮術を行った先天性両側横隔膜挙上症の1例

Bilateral congenital eventration of the diaphragms treated with laparoscopic plication

◆要旨：先天性両側横隔膜挙上症に対して腹腔鏡下に一期的両側横隔膜縫縮術を行ったので報告する．患者は4か月，男児．日齢1より多呼吸が出現し，4日間の人工呼吸管理を施行された．入院時，両側横隔膜挙上を認めた．4か月時，ウイルス性細気管支炎で再び人工呼吸管理となり，その後も酸素離脱が困難なために手術を施行した．臍下より5mmトロッカーを挿入し，腹腔内を観察した．両側横隔膜の菲薄化は著明であった．心窩部，左右上腹部に各々5mmポートを追加し，両側横隔膜縫縮を行った．術後6日目に酸素を中止した．腹腔鏡下横隔膜縫縮術は胸腔容積の少ない乳児でも広いworking spaceを確保でき，体位変換なく両側を縫縮できるために有用であった．

　Bilateral congenital diaphragmatic eventration is rare, and the mortality rate is higher than that for unilateral eventration. We report a patient with bilateral congenital diaphragmatic eventration treated with laparoscopic plication. A 2.9kg male infant was born at 40 weeks. He had respiratory distress at 1 day after birth and required respiratory assistance for 4 days. Chest X-ray showed bilateral diaphragmatic eventration. At 4 months of age, he underwent laparoscopic surgery for bilateral congenital diaphragmatic plication. Laparoscopic diaphragmatic placation was performed in the supine position under general anesthesia. A 5mm trocar for laparoscope was inserted in paraumbilical incision. Three additional working ports were placed in the upper abdomen. The bilateral diaphragms appeared loose and reduced in thickness, and were easily extended upon gripping with forceps. We sawed the bilateral diaphragms to generate adequate tension by a U-stitch or single knot with non absorbable 2-0 sutures. The postoperative course was uneventful, and his respiratory problems were soon resolved after operation. Laparosopic surgery for bilateral congenital diaphragmatic eventration is a useful minimally invasive surgical technique.