切除肺病巣内の結核菌培養成績からみた非空洞性肺結核症例に対する治療法の選択 (第1報)

抄録

This study was carried out to determine the method of treatment for non-cavitary tuberculosis cases with negative sputum for more than 6 months based on culture findings of tubercle bacilli from 71 lesions which had been resected during 10 years' period from 1965 to 1974 at the Research Institute Sanatorium. Cases used for this study were divided into several groups by the regimen of chemotherapy, the pretreatment radiological as well as bacteriological findings and the preopera tive size of lesions on radiogram. The bacteriological findings obtained were divided into 3 cate gories; smear negative-culture negative, smear positive-culture negative and culture positive for tubercle bacilli.
The culture positive rate of tubercle bacilli was only 2.8% (2 out of 71 cases) and there was no relation to the duration of negative sputum, the size of lesions on radiogram at the time of operation, and the pretreatment radiological and bacteriological findings (Table 3). Moreover, the amount of tubercle bacilli cultivated from these lesions was very small; only one colony in one case and 2 colonies in the other cases. The proportion of smear positive-culture negative cases to all culture negative cases was 53.6%, and the rates were similar in the original and other groups of chemotherapy, in the different size of lesions on radiogram at the time of operation, and in several pretreatment radiological and bacteriological findings (Table 4). The amount of tubercle bacilli on smear was large in 10.8%, moderate in 37.8% and small in 51.4% of smear positive culture negative cases (Table 4).
Therefore, it can be concluded that the surgical treatment is not indicated for non-cavitary tuberculosis cases with negative sputum for more than 6 months under chemotherapy, except for cases showing an enlargement of lesion and/or new spread of lesions in surrounding area and/or positive conversion of tubercle bacilli in sputum which can not be controlled within 3 months.