小児期遷延性腎炎に対する扁桃摘出術についての臨床的研究

抄録

An efficacy on the treatment of tonsillectomy to the persistent glomerulonephritis was investigated in this study. Out of thirty five children with persistent glomerulonephritis determined by clinical diagnosis including a histopathological examination of renal biopsy, seventeen cases, who were assorted randomly, were tonsillectomized and the other eighteen cases treated by conservative therapy as a control.
All of thirty five cases were scruitinized in following clinical aspects; i. e., (a) age and sex, (b) comparison of therapeutic effects for improvement of clinical symptomes of nephritis betweentonsillectomy and conservative treatment, (c) influence by preceding infection, (d) relationship oftreatment effects to frequent tonsillitis or unusual ASLO scores and (e) an effect of tonsillectomy in relation to immunosuppressive therapy, tonsillar provocation test and histopathological findings after renal biopy.
1. Tonsillectomy was a beneficial remedy in 88.2% of children who suffering from persistent nephritis and it was significant at the 0. 05 level as compared with conservative therapy which showed the therapeutic effects in 50% of cases.
2. Nineteen out of thirty five children were under eight years old and twenty one were male.In the patients under eight years old 81% of patients had a restoration of clinical manifestation fter surgical or conservative therapy and it was significant at the 0.05 level in contrast with the patients over nine years old. In connection of remedy to the patients over nine years old and male patient, tonsillectomy showed higher therapeutic efficiency than conservative treatment.
3. Tonsillectomy revealed more fairly therapeutic efficacy which was significant at the 0.05 level than conservative therapy in the patients who had preceding infection or frequent tonsillitis.In the patients with ordinary ASLO scores, tonsillectomy seemed to be more effective than conservative therapy, however it fell short of significance at the 0.05 level. In the persistent nephritis of purpura type and insidious type, tonsillectomy appeared to bring on an improvement of clinical manifestations, however they fell short of significance at the 0.05 level.
4. All of the cases who showed a temporary improvement after immunosuppressive therapy, had the satisfactory improvement in clinical manifestations after tonsillectomy or conservative therapy.
5. Seven patients who were determined as the positive tonsillar provocation test before operation had a comfortable clinical improvement after surgery. Two out of four patients who showed negative tonsillar provocation test, had an improved clinical manifestation and others remained to be unchanged renal function