Research Article| Volume 89, ISSUE 3, P673-681, March 1955

Segmental resection for pulmonary tuberculosis

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      • 1.
        1. The basic pathology of tuberculosis is an indolent pneumonia which may (1) resolve, (2) fibrose or (3) caseate. Usually all three elements are present in every lesion.
      • 2.
        2. The basic physiology is not significantly changed by segmental resection, because only the diseased components are removed and compensatory mechanisms have already been effected.
      • 3.
        3. The indication for segmental or subsegmental resection is a fibrocaseous lesion with or without cavitation confined to one or two segments of a lobe, but still large enough that mature clinical opinion is doubtful of the patient's future security.
      • 4.
        4. The preoperative preparation is the same as for any major operation with special attention to laminagraphy and especially lateral laminagraphy.
      • 5.
        5. An anatomic segmental resection is done for moderate and far advanced lesions. In minimal lesions a wedge resection or local enucleation is possible. Subsegmental resections may also be done anatomically.
      • 6.
        6. Postoperative care must be vigilant. Patent airways (intratracheal suction), the control of pain, the use of antibiotics, the obliteration of dead space by complete reexpansion of the lung using active suction and checked by frequent postoperative x-ray examinations are important to a successful result.
      • 7.
        7. Tuberculosis is usually bilateral though not bilaterally active. Only the major active focus is removed by segmental resection. The importance of other foci is dependent upon the size and location. Anterior foci are less hazardous than those posteriorly.
      • 8.
        8. The problem of overdistention is not great after segmental resection, but obliteration of the dead space is essential to success. Occasionally, a periosteal plombage procedure without resection of the ribs is done in deference to this principle.
      • 9.
        9. In obliterative pleuritis mobilization of the lung is not done when the preoperative fluoroscopy reveals good diaphragmatic movement. The functional loss is less if a small tailoring surgical procedure is done in the thoracic vault.
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