| Resection and Thoracoplasty in Pulmonary Tuberculosis |
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Pill Whoon Hong, Kun Young Lee, Nam Jae Lee |
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Department of Surgery Yonsei University, Medical School, Seoul, Korea |
| 폐결핵에 대한 절제술과 성흉술의 임상적 관찰(217례보고) |
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홍필훈, 이근영, 이남재 |
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| Abstract |
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A total of 217 cases were operated upon for pulmonary tuberculosis, among these, 152 were operated in the 4 year period between 1956 to 1959. There were 134 resection and 83 thoracoplasties, the ratio being 1.6:1. The over-all operative mortality of 217 cases was 1,8%; the operative mortality for resection being 2.2% and for thoracoplasty 1.2%. Major complications arose in 14 or 10.4% of the entire resected cases and, among these, empyema with or without bronchopleural fistula was the most prominent feature(6%). However, all of these responded favorable to intercostal drainage alone or in combination with a small-scale thoracoplasty. 82 patients were followed from 6 months to 4 years after surgery, Among these, 68 reached an inactive stagem 13 remained active and 1 died 9 months and uremia. Follwing factors, among others seem to influence the outcome of operation in a significant way.
1. Patients in the age group of 21 to 30 appeared to do poorly(79.0% inactive state) as compared to either younger or older patients.
2. The severity of the disease had a definite bearing on the outcome of the operation. In far advanced cases, the patients who reached inactive stage was only 80.8% as compared to 85.7% in moderately advanced and 100% in minimal cases.
3. Cases who showed positive sputum preoperatively showed poorer result(82.8% inactive state) than sputum negative cases(90.0% inactive state)
4. There was essentially no difference between resection and thoracoplasty as far as the results are concerned. Following resection, 82.6% reached inactive state as compared to 83.4% in thoracoplasty. Also the patients remaining active were 15.4% in the resected cases and 16.6% in thoracoplasty patients.
5. Patients who underwent surgery during the first 2 years of disease did poorly as compared to those whoo had surgery after 2 or more years of disease. This seem to indicate that the latter group obtained better result because of their natural resistance against tuberculosis. Majority of these patients were operated on under no sanatorium care, after prolonged irregular anti-tuberculosis therapy and in highly advanced state. Even under this unfavorable conditions, the results appear to be acceptable. In this series, the outcome following thoracoplasty is equal to or even superior to pulmonary resection, particularly in view of the fact that thoracoplasty cases were much more advanced than the cases selected for resection. It is suggested that resectional therapy be retained as the procedure of choice in selected cases and that thoracoplasty be reserved as a procedure which and be highly effective in cases whose disease condition is less amenable for resection. |
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