肋膜外合成樹脂充填術後, 後期の病理解剖學的所見

抄録

Late complications of the extrapleural Lucite plombage were studied pathologically on 33 consecutive cases (4 autopsy and 29 extraction operation cases).
1) A marked collapse of the lung tissue was found near the extrapleural pocket. However, contrary to our expectation the collapse was only limited to about 1cm. in depth from the base of the pocket, other parts being cnly slightly obliterated 2) The base of the pocket was markedly weak as compared with the pectoral margin. This constitutes a causative factor for a perforation.
3) Both the extrapleural pocket and lucite spheres were walled off by fibrinoid membranes. However, there was fcund no definite tissue reactions.
4) The local infection of the pocket from the closely situated pulmonary lesion is the ultinate cause of the perforation and of empyema. (In two of the series of non-perforation cases an active tuberculous lesions were found between the lung and base of the pocket, and in all perforated cases broncho-pleural fistulae were observed att the site of pre-existing tuberculous lesions.) Followings may be considered as causative factors for these complications. (1) the presence of pleural space (2) the weakness of the base of the pocket. As the lucite is non-irritant the tissue does not develop a defense reaction against spheres.
5) Post-operative bleeding was slight and there was no recurrence of it noted.
6) Fibrinoid membrane which formed around spheres may grossly be classified into following six groups, and the findings are listed in the table.
In the course of above findings changes may take place from one type to other, for instance Type 1 may change to Type 6 via Type 3, and from Type 4 to Type 6 via Type 5. This change indicates a process of perforation. Although it is not definite whether all the cases which showed no complications in their early stages, had the period of Type 1 or not, a changing pattern from Type 4 to Type 1 may occur in the early post-operative period.
Instances of Type 4 were encountered more often than of Type 1 in cases in which one year or longer period had elapsed after operation. Since Type 4 is a late complication another changing pattern i. e. from Type 1 to Type 4 via Type 2 may occur. Of late the number of cases in which 2 years or longer had elapsed after the operation has been rapidly increasing.