4回の開腹手術既往のある横隔膜ヘルニアに対してHybrid VATSによる修復術を施行した1例

A case of diaphragmatic hernia in a patient with a past history of four abdominal operations for which an operation for repair of the diaphragmatic hernia was performed with Hybrid VATS

◆要旨：横隔膜ヘルニアは症状の有無により，対症療法でよい症例から緊急手術を要する症例まで様々で，根治的治療は胸腔鏡を含めた経胸式または腹腔鏡を含めた経腹アプローチによる修復術である．今回，4回の開腹手術の既往があり，便秘と胸部不快感を有した患者の横隔膜ヘルニアに対して，胸腔鏡補助下手術（VATS）に小開胸を併用したHybrid VATSによる修復術を施行した．術後6日目に退院し，横隔膜ヘルニアの再発なく外来通院を継続している．開腹手術の既往により，腹腔内に高度な癒着が想定され，腹腔内からのアプローチが困難と予想される横隔膜ヘルニアに対して，Hybrid VATSはきわめて有効な術式と考えられた．

　There are various treatments ranging from symptomatic therapy to an emergency operation for cases of diaphragmatic hernia depending on the symptoms, and a radical cure is achieved by a surgical operation for repair of the diaphragmatic hernia through a chest approach using thoracoscopy or an abdominal approach using laparoscopy. We decided to perform an operation by a surgical approach that combined muscle-sparing mini-thoracotomy and video-assisted thoracic surgery（Hybrid VATS） for a patient suffering from symptoms of diaphragmatic hernia with constipation and chest unpleasantness who had undergone abdominal operations four times. The patient's postoperative course was uneventful and she was discharged six days after the operation and has continued to receive regular outpatient treatment without recurrence of diaphragmatic hernia. Hybrid VATS is very useful for patients with diaphragmatic hernia who might have strong adhesion in the abdominal cavity that occurred after abdominal operations and for whom it is difficult to reach and repair the diaphragmatic hernia from an abdominal approach.