肺結核症の臨床並びに病理学的研究 : 特に化学療法より見た手術適応について

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This report is based on the study of 150 but of a total of 230 patients with pulmonary tuberculosis who have been operated on with resection of the lung in our sanatorium. The specimens of lung resected from these patients were examined histopathologically and bacteriologically, and the results were evaluated in terms of preoperative clinical picture, in order to have an assessment of the value of chemotherapy. 1. Chemotherapy consisting in the administration of 35-100 g of streptomycin and 400-3600 g of PAS has brought about obliteration of cavities and roentgenographic improvement of main lesions, and has converted patients from sputum-positive to sputum-negative. 2. The maximum effect of chemotherapy on cavities and main cavities in roentgenograms and on disseminated lesions was achieved in 6 to 9 months and 9 to 12 months, respectively, after the treatment had begun. There was marked reduction in its effect after those periods. 3. Conversion from sputum-positive to sputum-negative does not necessarily mean that lesions have become entirely free of tubercle bacilli. 4. A study of specimens of resected lung has shown that the patients given large doses of streptomycin and PAS do not always show a strong tendency to cure. In view of the above findings, it has been concluded that, when chemotherapy does not bring about obliteration of cavities and conversion from sputum-positive to sputum-negative, patients should by all means be referred to surgery. When roentgenograms show bronchial communication of a caseous lesion with the hilum, and bronchograms show indentation in the bronchial walls, patients will do well to be operated on. Whether a patient had better be operated on should be decided 6 to 9 months after chemotherapy has begun, and resection therapy should be given within 12 months.
千葉大学の論文
1959-09-28

肺結核症の臨床並びに病理学的研究 : 特に化学療法より見た手術適応について

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