Wolfart W
Offentl Gesundheitswes. 1990 Aug-Sep;52(8-9):506-11.
Surgical treatment of tuberculosis is now largely a thing of the past. After it had been realized that a tuberculous lung process can be cured by shrinkage, i.e. by reducing the volume of both the lung and the thorax, attempts were made to actively promote such shrinkage processes by means of suitable measures. The so-called collapse therapy was initiated by the Italian physician Forlanini in 1888. By pumping air into the free cavity of the pleura the diseased lung as brought into a state of dosed collapse so that infiltrative and cavernous processes could heal with scar formation. However, application of a pneumothorax was prevented by pleural processes that occurred frequently during the course of a disease, especially also as sequels to pleuritis. The operative alternative was an attempt to achieve lung collapse by surgery. Thus the idea was born to enable lung collapse by mobilising the external thoracic wall, i. e. by means of rib resection: this principle was known as thoracoplasty. A little later, attempts were made to circumvent such a crippling intervention by surgically detaching the lung "on target" over the diseased area and by filling the cavity created in this manner, with air to produce a so-called "extrapleural pneumothorax". Lung surgery advanced rapidly after intubation anaesthesia developed since 1945. It was now possible to remove isolated diseased parts of the lung, so that the collapse therapy receded more and more to the background. Side by side with this development of new surgical procedures drug treatment of tuberculosis made rapid progress.(ABSTRACT TRUNCATED AT 250 WORDS)
如今,结核病的外科治疗在很大程度上已成为过去式。在人们认识到结核性肺部病变可通过萎缩,即通过缩小肺和胸廓的体积来治愈后,便尝试通过适当措施积极促进这种萎缩过程。1888年,意大利医生福尔拉尼尼开创了所谓的萎陷疗法。通过向胸膜腔的游离腔内注入空气,使患病的肺进入闭合性萎陷状态,以便浸润性和空洞性病变能通过瘢痕形成而愈合。然而,气胸的应用因疾病过程中频繁出现的胸膜病变而受到阻碍,尤其是胸膜炎的后遗症。手术替代方案是试图通过手术实现肺萎陷。于是,通过移动胸壁外层,即通过肋骨切除术来实现肺萎陷的想法应运而生:这一原则被称为胸廓成形术。不久之后,人们试图通过手术在患病区域“精准”分离肺,并向由此形成的腔隙内注入空气以产生所谓的“胸膜外气胸”,从而规避这种致残性干预。自1945年插管麻醉发展以来,肺手术迅速发展。现在可以切除肺部孤立的患病部分,因此萎陷疗法越来越退居幕后。在新的外科手术发展的同时,结核病的药物治疗也取得了迅速进展。(摘要截选于250字)