No abstract

The operation of pulmonary resection for tuberculosis is of such comparatively recent origin that, despite the wide extent to which it is being used, little is yet known of the conditions which subsequently obtain in the residual lung tissue.It is well recognized that, in the absence of spacereducing procedures such as thoracoplasty, plombage, or diaphragmatic paralysis, over-distension of the remaining lung is an almost invariable sequel. Many workers consider that this may have two undesirable results: (a) ipsilateral reactivation due to direct traction on incompletely healed lesions, and (b) diminution in pulmonary function. Opinions, however, differ as to the degree of risk involved in the various kinds of resection and as to whether a space-reducing procedure, e.g., a corrective thoracoplasty, is necessary in all cases or whether it should be used only where a large amount of lung has been removed. There are no published accounts of attempts to study the problem on an anatomical basis.A knowledge of the extent to which the remaining segments are separately affected by over-distension would appear to be essential in estimating the probability of reactivation of the foci in those segments. Is Lastly, nothing is apparently known as to the presence or otherwise, after resection, of kinking or other distortion of the bronchial tree with its attendant risk of pooling of secondary infection. PURPOSE OF THE PRESENT INVESTIGATIONThe present work was undertaken to determine how far answers to the above problems could be obtained by post-operative bronchographic study.Four objectives were kept in view: (1) To determine to what extent and in what anatomical manner the remaining pulmonary segments fill the space after the various types of resection; (2) to study the nature and the degree of over-distension by observing the distribution of attenuation of the bronchial tree; (3) where a space-reducing procedure has been carried out, to consider its success in preventing over-distension; (4) to note the occurrence, if any, of kinking or other distortion of the larger bronchi.