薬剤耐性肺結核例に対する外科療法の再検討

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This study was carried out to review the result of surgical treatment through its successful rate, mortality rate and the incidence rate of post-operative complication, and to elucidate the selection of surgical procedure for the bacilli positive and drug resistant cases of pulmonary tuberculosis. The material consisted of 7, 951 cases who had undergone the operation during the period from 1961 to 1964 at 51 institutions belonging to the Tuberculosis Research Committee (Ryoken) and had been observed for the period of at least 6 months post-operatively. After they were divided into some groups by means of their pre-operative background factors, the result obtained in each group was compared. In this study, the cases with negative sputum who had already returned to work during the period of follow-up were defined as successful cases, which was same to our previous reports. The mortality rate was calculated for cases, whose death related to operation or worsening of tuberculosis.<BR>The results of surgical treatment were analyzed according to pre-operative sputum findings. In the positive-resistant cases, the successful rate was 67.5%, the sputum negative rate was 76.7%, the death rate was 6.4% and the rate of post-operative complication was 12.9%, wheras the rate was 71.6%, 86.6%, 4.2% and 8.8%, respectively in the positive-sensitive cases. A highly significant difference was observed in the results between both groups. The result was better in the bacilli negative cases than in the bacilli positive cases, and the result in the positive-resistant cases with some sensitive drugs was significantly better than that in the positive-resistant cases without sensitive drugs (Table 1).<BR>Thus, the result of surgical treatment was the wors t in the positive-resistant cases without sensitive drugs, next in the positive-resistant cases with sensitive drugs, then in the positive-sensitive cases and the best in the negative cases.<BR>Observing the result of surgical treatment by p r e-operative amount of bacilli discharge, * From Subcommittee of Surgical Treatment (Chief: Y. Kano), Tuberculosis Research Committee (Ryoken) c/o Inform, Sect., Japan Anti-Tuberculosis Association, Kekkaku Yobo Kai Building 3-12, 1-chome, Misakicho, Chiyoda-ku, Tokyo 101 Japan. the result of the cases with large amount of bacilli was worse than that of the cases with small amount of bacilli with a highly significant difference. The difference in the results between these two groups was smaller in the positive-sensitive cases as compared with the Positive-resistant cases. The result of drug sensitive cases was obviously superior to that of drug resistant cases not only in cases discharging large amount of bacilli but also in cases discharging small amount of bacilli. However, the difference between the resistant and sensitive cases was smaller in the cases discharging small amount of bacilli than in the cases discharging large amount of bacilli (Table 2). These findings indicate that the emergence of drug resistance was certainly unfavourable but the large amount of bacilli discharge was more unfavourable for the surgical treatment. Observing by the pre-operative pulmonary function, the result of the cases with normal ventilatory function was better than that of the cases with lower ventilatory function.
日本結核病学会の論文

薬剤耐性肺結核例に対する外科療法の再検討

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