| Study for the Pleural Adhesion in the Pulmonary Tuberculosis |
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J. S. Kim, W. Y. Lee, J. H. Kim |
1Thoracic Surgeon, 36th A.H
2Shin-Saeng Sanatorium.
336th A.H. |
| 폐결핵의 근막유착에 대한 관찰 |
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김진식, 이완영, 김종헌 |
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| Abstract |
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A study consisting of the morphologyical and pathological investigation for the pleural adhesion obtained from 100 cases oof the pulmonary resection for the tuberculosis was performed at the Thoracic Surgery Section in 36th A. H, Masan, Korea, from 1954 through 1956 in presented, and the following conclusions were drawn.
1). Following classifications for pleural adhesion were performed by authors. (See annexed photo)
a) . Classification from the extension of pleural adhesion. Diffuse and loose type.....6 cases. Localized fibrotic type ... .. 4 cases. Cicatrical type on upper portion ..... 36cases. Cicatrical type on ùþper portion plus diffuse and loose type . .... 34 cases. Entire cicatrical type ......... 8 cases. Caseous pleural adhesion .....1 cases.
b) . Classification from the internal construction of adhesion: 1st type ..... 12 case. 2nd type .....11 cases.
3rd type..... 24 cases. 4th type.....42 cases.
C) . Classification from the point of external form: Thready form ......... 7 cases.Stringy form ......1 3 cases.
Band-like form .....11 cases. Mass form..... 21 cases. Dense closed-form Fibrotic type..... 5 cases. Cicatrical t.ype.....32 cases.
d). Classification from pathological view. A type adhesion ..... 11 cases. B type ..... 78 cases. A type adhesion logical.
2). Of 100 cases of pulmonary resection of tuberculosis, 89% were combined with pleural adhesion, and 80% of this adhesion were the cicatrical type on upper portion and 47% were the 4th type adhesion.
3). 80% of these pleural adhesion were localized on the apico-posteriol chest wall over the level of the 4th rib, and 60% were combined with the adhesions of interlobe, mediastinum and diaphragms , besides adhesion above the pulmonary tuberculous Iesion.
4) , The pleuraI adhesion became more dense and more diffuse in these cases which had passed through the pleurisy and artificiaI pneumothorax, in the side in which the primary complex was seen, and in the cases of Iong standing patients.
5) . The density and strength of pleuraI adhesion above the pulmonary tuberculous lesions are affected by such as the distance of pulmonary tuberculous lesions from the surface of visceral pleura, Pathological activity of the Iesions, and the intensiw of the collagen fiber under the pleuraI surface and around the lesions.
6). All such cases as the cirrhotic cavities, giant cavities and multiple cavities were alwayes combined with cicatricaI adhesions. lt, however, can not be decided hat there may be no cavities of there is no pleueaI adhesions.
7). The pleural adhesions were surmized from the roengenogram in 61% of resected pulmonary tuberculous cases. and the thickend pleural adhesions usuaIly caused the postoperative haemorrage of the thoracic cavity and the incomplete expension of remained Iung.
8) . HistologicalIy, in pulmonary tuberculosis, the pleuraI adhesions are mostely (87%) B type of adhesion, and the A type of adhesion are seen usualIy in cases which passed through the pleurisy and artificiaI pneumothorax.
9) . In such cases of short termed patients, exudative lesions right below the pleuraI surface, and isolated cavities and tuberculomas which are distant from the pleuraI surface, the pleural adhesions are free or slight.
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