Abstract
Therapeutic effects of the surgical treatment for pulmonary tuberculosis in 52, 234 cases treated in 157 national sanatoria for the period from beginning of 1952 and the end of 1957 were investigated in August, 1959. Forty point four per cent of the total cases under went surgical collapse therapy and 58.3 per cent surgical direct therapy. Ninety three point three per cent of surgical collapse therapy performed is thoracoplasty and 96.7 per cent of surgical direct therapy is pulmonary resection, and these two are the representatives of the modern surgical treatment.
The advent of chemotherapy made thoracoplasty retreat and pulmonary resection proceed impetuously, but afterwards pulmonary resection retreated and thoracoplasty increased slightly again with the peak in 1956. This phenomenon is considered to be due to the remaining of far-advanced cases and the aged cases and to reconcideration of pulmonary resection and reperception of thoracoplasty.
A number of the cases alive 8 years after thoracoplasty is almost same with that in resection cases. A close study of causes of death, however, disclosed that there were more deaths directly related to surgical intervention itself following pulmonary resection and that thoracoplasty was followed by late deaths even years after surgery.
As concerns ages of patients, pulmonary resection is frequently performed in the yourger and the middle-aged and thoracoplasty is preferably applied to the aged. As concerns extents of disease, pulmonary resection is generally performed in moderately advanced or minimal cases and thoracoplasty is often performed in advanced cases.
Several surgeries other than pulmonary resection and thoracoplasty are considered to have practically a very limited stage opened for them, and it should be emphasized that the indications of these surgeries has to be closely investigated.
Full attention should be paid not only to patho-anatomical changes of the diseased lung but also to respiratory function of the patient when surgery is considered. Postoperative death rate becomes considerably high in cases whose preoperative vital capacity is lowered below 60 per cent of its predicted value.
No major complication is found particularly in thoracoplasty cases. In pulmonary resection cases, broncho-pleural fistula is pointed out as major complication.
In cases with resistant bacilli, broncho-pleural fistulae occur more frequently when partial resection, segmental resection, and/or multiple resection are performed than when lobectomy and/or pneumonectomy are performed.
As occurence of broncho-pleural fistulae makes postoperative prognosis remarkably poor, the utmost care should be taken in order to prevent occurence of fistulae when pulmonary resection is performed.
