AN EXPERIMENTAL STUDY OF THE INFLUENCE OF LIGATION AND DIV1SION OF THE BRONCHUS ON PULMONARY TUBERCULOSIS

Abstract

Introduction:UP to now, thoracoplasty and Pulmonary resection have been used for the treatments of the choice for cavitary Pulmonary tuberculosis. In fact, the vast majority of the patients have those surgical treatments but significant number of patients could not have been cured surgically. This experiment is intended to know what kind of surgical treatment should be used for the cause of whom the above surgical therapy is not indicated. Many devices have been made for the auto-occlusion of bronchus. Sudden and dramatic cavity closure occurred in unpredictable ways under the influence of pneumothorax, thoracoplasty and even phrenic nerve paralysis. The bronchial occlusion is very important to heal the cavity on pulmonary tuberculosis. Since 1844, this con cept has been accepted by Mendelssohn and Lichtheim experimentally and clinically. This experiment has been planned to study the influence of the operative Ebroncheal occlusion upon the pulmonary tuberculosis using thirty animals(21 sheep and 9 dogs).Material And Methods:The animals were divided into three groups, and the following procedures were done.1) Group 1: consisted of 3 sheep and 3 dogs which have undergone Ligation and Dvision of the right upper lobe Bronchus to observe at influence of atelectasis on normal lungs.2) Group 2: consisted of 8 sheep and 6 dogs which were inoculated with 2.5mg of Boviene type Ravenel Mycobacterium tuberculosis strain suspension mixed with Lanolin liquid-paraffin adjuvant 1.0ml to investigate the nature of the lesions after treated with this procedures.3) Group 3: consisted of 10 sheep, which have undergone Ligation and Division of the bronchi seven seeks after inoculation of the same amount of Mycobacterium as in the group 2, to investigate the effect of an operative Ligation and Division upon experimental pulmonary tuberculosis. Results:1) The atelectasis was induced by Ligation and Division of the lobar bronchus in healthy animals group successfully.2) The pulmonary tuberculosis lesion were induced successfully by instillation of the tuberculous strain in pre-experimental sheep group.3) The following facts were found after Ligation and Division of the bronchus of the inoculated sheep. The cavity was compressed and lobe was in atelectatic. Inspissation were observed instead of evacuation of the cavity content. There were thick fibrous layers on the cavity walls rather than extension of the tuberculous lesion to the surrounding lung parenchyma. Fifteen to thirty weeks later, fibrotic tissue was growing into the cavitary caseous layers also there were significant tendency to the calcification and scar formation. In atelectatic lung, the tuberculous lesion showed a definite tendency to localization of the feci. In the adjacent lobe which was not ligated, there were spreading tuberculous lesions.Conclusion:1) The successful lobar atelectasis developed by means of the Ligation and Division of the lobar bronchus.2) The pulmonary tuberculosis cavity could be developed in the sheep with instillation of Mycobacterium Ravenel strain Lanolin Liquid-paraffin adjuvant, but no confirmatory tuberculous lesions could be developed in dogs with the same procedures.3) The atelectasis which was made by Ligation and Division exert a distinctly favorable on the healing of tyberculous lesion.4) It is speculated that this healing comes from the pulmonary collapse, hypoxia, fibrosis and inhibition of the mycobacterial proliferation.