タイ国における肺結核の現状 : 肺結核外科を中心として

Abstract

I was in Thailand from Dec. 13, 1964 till Feb. 1, 1965 to investigate the present condition of pulmonary tuberculosis from the standpoint of surgical treatment. As the result, I have been able to obtain the following conclusion. 1) It is said from the report of Tuberculosis Control Division in Thailand that about 6% of all Thai peopele show abnormal findings in X-ray of chest, about 4% need the treatment for tuberculosis and about 1% have tuberculous cavities or have positive sputa. 2) From my investigation, it seems that chemotherapy would not be effective in abot 30% of the case in which cavities or positive sputa are found, because the insufficient chemotherapy with only INH, PAS and Tb 1 has to be performed by the economical condition and most of the above cases have cirrhotic cavities for which even the most excellent chemotherapy are often ineffective. Therefore, to eradicate of tuberculosis in Thailand, it may be necessary to treat these cases surgically. 3) There are two hospitals for surgical treatment of pulmonary tuberculosis in Thailand and about 200 cases per year are operated surgically. However, most of the beds in the both hospitals are occupied by the far-advanced cases and it is not so easy to find out the case with good indications for surgical treatments. As the result, the rotation of bed for surgical operation is insufficient and the function of the surgical division is much disturbed. 4) As is well known, methods available for surgical treatment of pulmonary tuberculosis are pulmonary resection, thoracoplasty and cavernostomy, and for the far-advanced cases, cavernostomy can be available even when pulmonary resection and thoracoplasty are impossible. But, in Thaiand, only pulmorary resection and thoracoplasty are being done. This is a cause of those beds for surgical treatment are occupied by patients with far-advanced tuberculosis and the rotation of bed is apt to be stopped, because many cases of far-abvanced in Thailand have no indication for pulmonary resection or thoracoplasty, but have only the indication for cavernostomy. 5) In fact, we can find the indication of pulmonary resection and thoracopasty in only about 10% of all patients of Central Chest Hospital and on the other hand, we can find the indication for cavernostomy in over 30% of the same group of patients. 6) Therefore, it can be said that, if cavernostomy is performed in suitable patients among these far-advanced cases, the rotation of bed in this hospital will be better and this will help to eradicate tuberculosis in Thailand.