小児期の気管支拡張症に関する臨床的研究

特に予後に関する1考察

抄録

A clinical follow-up study on bronchiectasis in 116 children, who had been diagnosed between 1951 and 1971, showed the following results:
1. Subjective course and prognosis:
Coughing, sputum and other respiratory complaints were remarkably reduced in both operated and non-operated groups and almost 80% of the patients feel recovered from their pulmonary disease and spend a normal school life or are able to work without any trouble.
2. Objective course and prognosis:
In the non-operated group, bronchographic findings showed that the ectatic bronchi still had remained in all cases after 1-21 years process and furthermore, newly ectatic bronchi were noticed. In the operated group, bronchographic findings showed that no ectatic bronchi had appeared in completely resected cases, but in incompletely resected cases ectatic bronchi had newly developed or ectatic tendencies were noted. Pulmonary function tests such as vital capacity, one-second forced expiratory volume and maximum voluntary ventilation revealed no remarkable differences between the operated and non-operated groups. Normal volume was noticed in the completely resected group, but in the non-operated group, residual volume had increased.
3. General results:
In the non-operated group, no one had recovered completely and only 28.6% had slightly improved, 42.8% were almost unchanged and 28.6% had deteriorated. In the operated group, 50.0% had almost recovered completely and of the improved cases almost 83.3% proved to have good prognosis, but 8.3% unchanged and 8.3% deteriorated cases were noticed. Considering the objective and subjective data, it is clear that there is a great discrepancy between the results of the objective and subjective course and progresses. This is an important point in seeking to cure bronchiectasis in children. Considering these points, 1 suggest the three following major principles in the attempt to cure bronchiectasis in children:
1) Complete resection of the invading focus should be performed after bronchography examinations and full consideration of the post operative pulmonary function.
2) Operation should be decided after observing irreversible changes of the bronchus after six months or one year follow up.
3) Treatment of bronchiectasis in children should be combined with antibiotics, drainage, treatment of complication and so on when necessary.