尿路結核知見補遺 第III篇:化学療法後腎摘出例の病理組織学的検討

Abstract

Pathological histology of renal tuberculosis has been s tudied on 68 cases with preoperative treatment with antiviotics more than 1 month and 36 cases of the control group (no specific treatment). The specimens were obtained by nephrectomy at our clinic during a 6 year period (1952-7). As a rule, nephrctomy was perfomed after a short pre-operative treatment at our clinic, then in the most of these cases the treatment had been carried out in various treatment regime by other physicians before our first examination. In the most of cases, the treatment was done with a combination of 2 or 3 drugs (SM, INAH, its derivatives, PAS, TB1 etc). The longest duration of treatment was 4 year. The matarial has been divided in to many groups according to the length of trearment, size and form of lesion and kindney function. The histological findings were then discribed The cleaning of cavity wall and epithelization of its surface in the open cavity were promoted by tratment in accordance with the length of it, but hindred in the cavity with worse communication to pelvis or bladder and in cases with impaired kindney function. And , as a rule, no sign of regression in the cavity was seen in the closed lesions. In the tissue of cavity wall and the tubercle the healing took place with disap p earence of giant cells, epitheloid cells and perifocal inflammation, and with the fibroblast proliferation. These phenomana were promoted in accordance with the length of treatment, but the correlation with the form and size of the lesion was not close. A remarkable fibrosis was recognized in some cases with a long term treatment. The individual difference was present as to fibrosis. The central caseation in tubercle was ceased and absorbed in the early stage of chemotherapy. The central caseation was found rarely in cases who were treated over 60 days. The presence of giant cells has been studied and recorded in the table. Number of cases Giant cells (+) 30-60 days 27 25 93 61-120 days 9 5 56 121-180 days 9 4 4 4 181 days-1 year 11 4 3 6 over 1 year 12 1 8 Out of 68 cases, there were 4 cases whose tuberculous renal lesions were cured and had no specific changes. The lesions of these cases were small and open lesions, and the length of treatment ranged in 1-4 years. A nephrectomy was performed in these cases in the period in which the opinion, that there was no complete healing in cavernous lesion, was predominant. N o wadays, medium sized lesions can be treated with drugs only, if there is no stricture in upper urinary tract and the kindney function does not be inpaired severely. The cure of extensive lesion and closed medium sized cavity should not be expected with antibiotic treatment only. The accurate diagnosis of closed cavity and perenchymatous lesion is very important to ditermine the indication of treatment.