| Clinical Study on 62 Cases of Pulmonary Resection |
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Yie Yoon Kim, Dong Soo Whang |
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Pusan City Branch Clinic, Korean National Tuberculosis Association, Pusan, Korea |
| 폐절제 62예에 대한 임상적 고찰 |
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김의윤, 황동수 |
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| Abstract |
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Sixty-two cases of pulmonary resections were performed among the 3,131 patients registered at Pusan City Branch Clinic of Korean National Tuberculosis Association for two years and eight months from Jan. 1987 to Aug. 1989. 47 cases were pulmonary tuberculosis, 13 cases were bronchiectasis, and pulmonary abscess and intralobar pulmonary sequestration was only one case respectively.
The clinical evaluations were as follows:
1) In the 47 cases of pulmonary tuberculosis, there were 36 (76.6%) male and 11 (23.4%) female patients, and in the 13 cases of bronchiectasis, 4 (30.8%) males and 9 (69.2%) females. 2) The duration of illness was 3.8 years in the pulmonary tuberculosis, and in the bronchiectasis, it was 16.2 years on the average respectively.
3) The extent of the diseases were 45 (96%) cases of moderately advanced and 2 (4%) cases of far advanced by NTA classification.
4) The resistance tests for drugs were done in 22 cases of sputum culture positive pre-operatively.
90.9% (20 cases) showed resistant to 1- 6 drugs, and the primary resistance (infection from patients with acquired resistance) were 2 cases. 5) Among the 12 sputum-negative cases pre-operatively, 75% of the necrotic lesions contained acid-fast bacilli in the resected specimens by a combination of smear and culture study, and Kass also reported that it reached to 89%. Therefore, patients with negative-sputum who have a residual destroyed lobe or blocked cavities and tuberculomas should be considered for resection.
6) In 13 cases of bronchiectasis, 12 patients were misdiagnosed as pulmonary tuberculosis and treated with anti-tuberculosis regimens for a long time. Generally, the lower lung field tuberculosis without concomitant upper lobe diseases is uncommon, and in the bronchiectasis, dependent segments are involved most commonly. Therefore, differential diagnosis should be done for these two illness thoroughly. 7) The author believe that the lobectomy is the most ideal surgical procedure for the pulmonary tuberculosis and the surgical decision is easy to make for those patients who continue to have postive sputum after an adequate trial of medical management beyond 6 to 12 months, since in these drug resistant cases a surgical solution is usually required. |
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