Abstract
During ten year interval from 1972 to 1981, 267 patients underwent thoracotomy for pulmonary tuberculosis or empyema at Seiranso Byoin National Sanatorium. Although there were 48 patients who required thoracotomy in 1973, only 15 patients were operated in 1981.
In recent years, the diagnosis of tuberculosis was made at surgery in one third of patients who underwent thoracotomy with preoperative diagnosis of lung cancer.
Although the advent of effective antituberculous agents has decreased the numbers of patients who need operation, it is also true that patients in whom operation is really necessary do exist.
From our experiences during these ten years, following comments can be made on interesting cases.
1) Bronchial tuberculosis: Six patients underwent thoracotomy. Five patients were female and one was male. Four patients underwent left upper lobectomy along with circumferential excision of the left main bronchus. In these cases it was possible to preserve pulmonary function of left lower lobe by performing bronchoplasty. Right middle lobectomy and pneumonectomy of the right side were performed in one patient respectively. In the latter case with tuberculous stricture of the right main bronchus, preservation of middle and lower lobe could have been possible if operation was performed one year early. From this experience we learned that we should not lose the timing of operation.
2) Empyema: Generally, if it occurs, bronchial fistula after pulmonary resection is seen from one to several weeks postoperatively. Bronchial fistula and empyema were seen in two patients after 17 years and in one patient after 22 years postoperatively. Result of surgery in these patients was excellent. A long time follow-up is necessary in patients undergoing pulmonary resection for tuberclosis.
3) Cases with positive smear and negative culture for tuberculous bacilli (abbreviated as SPCN): In one patient with SPCN for two years underwent right upper lobectomy. Although smear of resected specimen was reported to be positive for tuberculous bacilli (Gaffkey 8), only one of three cultures was positive.
In patients with long lasting SPCN for tuberculous bacilli, it should be considered that tuberculous lesion is more active than we have expected and surgical intervention should be considered.
4) Cases in which timing of operation was lost. In several patients who had been undergone pulmonary resection of contralateral side, we hesitated to perform operation and lost the good timing of operation. Three patients died of progression of tuberculosis. We realized that in patients with recurrent pulmonary tuberculosis, surgical intervention should be considered.
