Rifampicin導入による肺結核外科療法の適応変化について

主として切除肺病巣内の結核菌検索の成績から

抄録

The indication of surgical treatment for pulmonary tuberculosis should be changed with the advances in chemotherapy, as the surgical treatment is indicated after chemotherapy. Accordingly, the changes in the indication of surgical treatment with the introduction of rifampicin (RFP) were reviewed based on the bacteriological findings on culture of resected specimens.
The material consisted of 285 cases who had undergone pulmonary resection under the coverage of RFP at 23 institutions belonging to the Tuberculosis Research Committee (RYOKEN). They were divided into 5 groups; 29 original treatment cases with SM·INHP FP showing positive sputum, 125 retreatment cases with positive sputum, 111 retreatment cases with negative sputum, 15 retreatment cases with unknown findings of sputum and 5 original treatment cases with SM·INH RFP showing negative sputum, before the introduction of RFP.
The bacteriological examinations of tubercle bacilli on smear and culture were carried out for necrotic mass obtained aseptically from cavities or non-cavitary lesions of resected specimens just after the completion of operation in each case. The bacteriological findings were then evaluated in relation to the duration of negative sputum and of RFP treatment.
The culture positive rate of tubercle bacilli in the resected specimens was only 1.0% (1 case) among 98 cases with the duration of both negative sputum and of RFP treatment for more than 6 months.
One culture positive case was found in the retreatment cases with negative sputum before the introduction of RFP, and the reason of which could not be solved. Moreover, the positive rate was also the same in 32 cases with the duration of negative sputum for the period of 3 to 5 months after using RFP for more than 5 months. It was noticed that the proportion of smear positive-culture negative cases to culture negative cases in resected specimens was as high as 47.4%.
The following conclusion could be obtained on the indication of surgical treatment: Cases showing negative sputum for more than 6 months by applying RFP treatment might be excluded from the indication of surgical treatment in the near future. It is also most likely to exclude cases with negative sputum for 3 to 5 months from the indication of surgical treatment. However, the final decision should be made after waiting for the results of further researches, as many problems such as the viability of smear positive-culture negative tubercle bacilli still remained unsolved.