切除肺病巣内の結核菌検索成績からみた化学療法終了時期と外科療法適応の予測
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概要
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This study was carried out to predict the time of terminating chemotherapy and the indication of surgical treatment for pulmonary tuberculosis based on the bacteriological findings on culture of resected specimens. The material consisted of 491 cases including 324 cavitary cases and 167 noncavitary cases before the operation who had undergone the pulmonary resection after getting negative sputum for the period of more than 6 months at 24 institutions belonging to the Tuberculosis Research Committee, Ryoken. Tubercle bacilli were examined on smear and culture in necrotic mass obtained aseptically from cavity and caseous mass in resected specimens immediately after the operation.<BR>The culture positive rate of tubercle bacilli in resected specimens was 7.7% in all subject cases, and 9.9% in cavitary cases and 3.6% in noncavitary cases before the operation (p<0.05), and 9.0% in positive sputum cases and 5.6% in negative sputum cases before starting chemotherapy (p<0.1) (Table 1). This rate, however, depended upon the background factors of subject cases which could be divided into 4 groups by radiological findings before the operation and bacteriological findings before starting chemotherapy. It was 10.5% in cases with cavity and positive sputum, 6.8% in cases with cavity and negative sputum, 5.4% in cases with closedlesion and positive sputum and 3.8% in cases with closed lesion and negative sputum (Table 1).<BR>The culture positive rate of tubercle bacilli in resected specimens seemed to relate to the intensity of regimens, i. e. zero in SM·INH·RFP, 1.2% in retreatment regimens containing RFP, 7.7% in SM·INH·EB, 9.3% in SM·INH·PAS and 9.8%, in retreatment regimens without RFP. This rate was analysed in cases with cavity before the operation and positive sputum before starting chemotherapy, as it might be influenced by background factors. It was zero in SM·INH·RFP as well as retreatment regimens containing RFP, 10.0% in SM·INH·EB, 15.4%in SM·INH·PAS and 19.0% in retreatment regimens without RFP (Table 1).<BR>Observing the culture positive rate of tubercle bacilli in resected specimens by the duration of negative sputum before the operation, it did not show any relation to the duration of negative sputum (Table 2). Moreover it was also zero in 22 cases with negative sputum for the period of 3 to 5 months before the operation attained by SM·INH·RFP as well as retreatment regimens containing RFP.<BR>Examining the culture positive rate of tubercle bacilli in resected specimens in relation to the thickness of cavity wall and size of noncavitary lesions on tomograms before the operation, it was rather higher in cases with thickwalled cavity (more than several milimeters), cavity in sclerotic lesions and multilocular sclerotic walled cavity but not related to the size of caseouslesions (Tables 2 and 3).
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