精密X線検査による縫縮術の遠隔成績

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Ten years have passed since Professor Kawai developed a new surgical procedure for the treatment of pulmonary tuberculosis. This procedure, called extrapleural pneumonolysis with pneumonorrhaphy (pneumonorrhaphy), has been applied to quite a large number of cases, and those that were operated on by this procedure alone more than 2 years before with known results are 117 in total. The author examined the follow-up results of the operation on these cases both roentgenographically and clinically. Of the 117 cases, 82 cases were examined in detail not only by routine chest roentgenography but also by wide angle serial tomography and selective bronchography. I. The Results of Clinical and Roentgenographic Tests Of all the cases examined, 72.4 % have returned to normal economic life, while 9 % still produced sputum positive for tubercle bacilli. The cases that had had soft cavities of less than 2 cm in diameter in the apex and upper lung field or those that had had circumscribed lesions before the operation showed good results. II. The Evaluation of Pneumonorrhaphy on the basis of detailed Roentgenographic Examinations 1. The cases under examinations were grouped into the following three categories in accordance with the degree of collapse of the lung produced as a result of the operation : 1. High degree of collapse; 2. Medium degree of collapse; and 3. Moderate degree of collapse. The majority of the cases belonged to either category 1 or category 2. 2. The deformation of the bronchus occurred in R. apicalis more often than in any other bronchi in both lungs. 3. Examinations revealed that 76.5% of the cavities with a diameter of less than 2 cm had been lost to sight. It was often observed that the lesionshad . become circumscribed after the operation. It was also disclosed that 68.4 % of encapsulated caseous foci had grown small in size.4. Follow-up examinations revealed that the cases belonging to category 1 (high degree of collapse) had attained the best results, followed by those belong to category 2 (medium degree of collapse), while those belonging to category 3 (moderate degree of collapse) had shown bad results. The cases, in which only a slight degree of bronchoectasy had developed in the postoperative period, showed good follow-up results. Conclusions In view of the above-mentioned results of follow-up examinations of the cases that underwent preumonorrhaphy, it may be said that this surgical procedure has been effective in the treatment of pulmonary tuberculosis. In recent years, lung resection have come to be employed extensively. This procedure, however, entails special facilities and high technical skills. Therefore, pneumonorrhaphy, that can easily be performed, might sometimes be substituted for resection with better results. As the functional disturbances can be minimized under this procedure, it would be effective in the treatment of cases where both lungs are involved or residual lesions still have to be operated on after resection therapy.
千葉大学の論文

精密X線検査による縫縮術の遠隔成績

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