成人横隔膜弛緩症に対して胸腔鏡下横隔膜縫縮術を施行した1例

Video-assisted thoracoscopic plication for elevation of the diaphragm in an adult

◆要旨：患者は33歳，女性．10年ほど前から左横隔膜挙上を指摘されていたが経過観察となっていた．徐々に嚥下困難感や嘔気嘔吐などの症状が出現してきたため当科を紹介され，手術の方針となった．手術は片肺換気とし，炭酸ガスによる6mmHgの気胸下に胸腔鏡下に単結紮で縫縮を行った．肋骨横隔膜洞側は，緊張が強かったため，両端の正常な横隔膜筋の間に弛緩部の横隔膜を折りたたむように縫合した．術後，症状は軽減し，術後7日目に退院となった．横隔膜弛緩症は成人では比較的稀な疾患とされているが，新生児も含めると様々な手術方法が報告されており，若干の文献的考察を踏まえて報告する．

　A 33-year-old woman with a 10-year history of left diaphragm elevation on chest X-ray and computed tomography scan was admitted to our hospital with gradual development of dysphagia and nausea. The patient underwent video-assisted thoracoscopic surgery. Single lung ventilation with capnothorax and an insufflation pressure of 6 mmHg was used. The redundant diaphragm was plicated with interrupted sutures. To strengthen the normal diaphragm which had become weak, the redundant diaphragm was then tucked into the normal diaphragm at the costodiaphragmatic recess. The postoperative course was uneventful, and the patient was discharged on the seventh postoperative day. Diaphragmatic eventration is relatively rare in adults, but many surgical techniques have been used for diaphragmatic plication, including neonates. We describe a case of diaphragmatic eventration and demonstrate our surgical technique.