Abstract
Since reports on the prevention and the closing method of the ramnant cavity of lower or middle lower lobectomy of pulmonary tuberculosis are few, there are a number of problems yet to be solved in this connection. Reported in the present paper are the findings of the effect of phrenic anesthesia and upper thoracoplasty applied in combination with lower or middle lower lobectomy. The results obtained were as follows:
1. Phrenic anesthesia should not be applied in combination with lower lobectomy as it reduces pulmonary functions. Remnant cavity closes by itself without the application of anesthesia.
2. As for the upper thoracoplasty, a modification was devised in order to retain the motility of the 6th rib which is impaired by Björk's osteoplasty.
3. Lobectomy applied in combination with upper thoracoplasty leaves less post operational changes on the diaphragm and the pleura. In spite of the disadvantage of thoracoplasty, it maintains excellent diaphragmatic movement and accordingly pulmonary functions.
4. Lobectomy combined with upper thoracoplasty produces marked diminution of the Segment 1 and Segment 2 and therefore is effective on the lesions left in those segments. It produces, however, an excessive swelling of the Segment 3. This combined application of upperthoracoplasty, moreover, appears to be effective also on the lesions of the counter side.
5. This author's Serial tomography is recommended for the determination of the lung volume with its shape before and after operation.
