Loss of ventilatory function after surgical procedures for pulmonary tuberculosis

Timed vital capacity and maximum breathing capacity estimations have been made on 272 male patients before and after different operative procedures for pulmonary tuberculosis. In a series of 20 patients tested twice pre-operatively the timed vital capacity estimation was more closely reproducible than the maximum breathing capacity estimation; it is also more acceptable to the patient and is, therefore, considered more satisfactory for clinical work. The results of the timed vital capacity estimations for the first second of expiration (TVC 1) before and after a variety of operations are reported in this paper. No correlation was found between the loss of ventilatory function produced by any specific operative procedure and either the age of the patient, the duration, site or type of the disease, or any operative complication. Segmental resection led to a mean loss of TVC 1 of 14·0 per cent; when thoracoplasty was also performed the loss was 29·1 per cent. Thoracoplasty alone produced a greater loss than segmental resection; when 5 ribs were removed the mean loss of TVC1 was 21·1 per cent; this loss rose with the number of ribs removed to 35·1 per cent with 8 ribs. Lobectomy led to a mean TVC 1 loss of 16·3 per cent which rose to 39·3 per cent when a thoracoplasty was also performed and to 33·0 per cent when a phrenic crush was performed. Lobectomy under a failed thoracoplasty resulted in a mean TVC 1 loss of 9·0 per cent for the lobectomy. Induction of a pneumoperitoneum resulted in a mean loss of 8·5 per cent in the TVC 1; when a phrenic crush was performed later there was a further loss of 19·1 per cent.