The present paper deals with the reexpansion of the remaining lung after pulmonary resection and its proper therapy. The authors have experiences of not a few cases of inscrutable complications and uselessly prolonged days of cure, and they were due to physicians' misunderstanding of the reexpansion. In order to set a standard for the diagnosis of the reexpansion, the authors made radiographical and clinical observations.
In 24 cases, direct radiographies were taken, once a week for a month after their operations, and once a month for six consecutive months. Frontal and lateral tomographies and bronchographies were also conducted every other week after operations. As for clinical findings, quantity of bleeding in operation and postoperative exsudate, body temperature, duration of bloody sputum were checked. Furthermore, thoracotomic views in additional thoracoplasties were recorded in cases of imperfect reexpansion.
1) Direct radiography was nearly able to clarify the condition of reexpansion. Lateral radiography had an additional value. There were 12 cases of successful results, 3 cases of procrastination, and 9 cases of imperfection.
2) Frontal and lateral tomography were worth for the observation of dead space and the nature of pleural peel, especially, in cases of procrastination and imperfection. Dead space existed partially on the ventral and lateral part of thoracic cavity as considered in additional thoracoplasty.
3) In case the quantity of bleeding was over 1, 000g, and that of post-operative exsudate was over 500cc, cases of imperfect reexpansion were common.
4) Duration of post-operative bloody sputum and higher temperature were used as convenient index for the reexpansion, and when both of them continued over 2 weeks, there was danger of imperfect reexpansion and complications.
5) In the thoracotomic observation of 9 cases of additional thoracoplasty, 7 cases of dead space formation, and 2 cases of bronchial fistula were found.
The authors practised additional thoracoplasty at 2 weeks after pulmonary resection, if imperfection was suspected in the early time. When early diagnosis was difficult, additional thoracoplasty shall be conducted at 4th week after operation for the cases in which the upper margin of remaining lung locates at the height of 5th rib and the lung picture is obscure and the formation of horizontal line is obvious. In these cases, rib-resection shall be carefully done with cGnsideration of dead space. As for procrastination, early thorahoplasty shall be put off and careful observation shall be taken for 12 weeks thereafter.
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