Bronchusinsuffizienz: Prävention und Therapie

 

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Zusammenfassung

Um ein gutes Ergebnis bei der Lungenresektion zu erreichen, muss man die Mechanismen der Bronchusheilung kennen. Der Verschluss sollte luftdicht sein und mit monofilem Nahtmaterial oder einer Klammernaht durchgeführt werden. Die Bronchusnaht soll von vitalem Gewebe (Restlunge, Mediastinum oder gestielter Lappen) gedeckt sein. Die Komplikation der Bronchusheilung soll so früh wie möglich erkannt werden, um die zerstörende Wirkung der Infektion zu stoppen.

Abstract

In order to achieve respectable postoperative outcomes after lung resection it is essential to understand the mechanism of bronchus healing. The bronchus seal should be air-tight and consist of monofilament suture or staples. The bronchus suture should be covered with vital tissue (lung, mediastinum, muscle flap). A complication in the process of bronchus healing should be diagnosed as early as possible in order to stop the destructive effect of the infection as rapidly as possible.

• Literatur

• 1 Barthel E, Schone U, Scheuerlein H. [How should surgical education and training be designed ideally? – answers and suggestions of a surgical resident]. Zentralbl Chir 2010; 135: 464-466
  Article in Thieme ConnectPubMedGoogle Scholar
• 2 Hornung HM, Jauch KW, Strauss T et al. [Economic consequences of complications in abdominal and thoracic surgery in the German DRG payment system]. Zentralbl Chir 2010; 135: 143-148
  Article in Thieme ConnectPubMedGoogle Scholar
• 3 Konrad RM, Ulrich B, Huth F et al. [Bronchial stump insufficiency after the use of a clip suture machine (author’s transl)]. Thoraxchir Vask Chir 1973; 21: 513-517
  PubMedGoogle Scholar
• 4 Scott RN, Faraci RP, Goodman DG et al. The role of inflammation in bronchial stump healing. Ann Surg 1975; 181: 381-385
  PubMedGoogle Scholar
• 5 Sturzenegger H. [Management of the bronchial stump in lung resection]. Ergeb Chir Orthop 1967; 49: 26-61
  PubMedGoogle Scholar
• 6 Stoppa RE. The treatment of complicated groin and incisional hernias. World J Surg 1989; 13: 545-554
  CrossrefPubMedGoogle Scholar
• 7 Korenkov M, Paul A, Sauerland S et al. Classification and surgical treatment of incisional hernia. Results of an experts’ meeting. Langenbecks Arch Surg 2001; 386: 65-73
  CrossrefPubMedGoogle Scholar
• 8 al-Kattan K, Cattalani L, Goldstraw P. Bronchopleural fistula after pneumonectomy with a hand suture technique. Ann Thorac Surg 1994; 58: 1433-1436
  CrossrefPubMedGoogle Scholar
• 9 Ludwig C, Behrend M, Hoffarth U et al. [Resistance to pressure of bronchial closures. Comparison of pressure resistance of manual and stapler bronchial closures depending on the angle to the cartilaginous rings]. Chirurg 2004; 75: 896-899
  CrossrefPubMedGoogle Scholar
• 10 Goffi FS, Goncalves EL. Closure of bronchial stump after pneumonectomy; comparison of some techniques through evaluation of tensile strength of suture. Surgery 1957; 42: 511-520
  PubMedGoogle Scholar
• 11 Getman V, Devyatko E, Abraham D et al. Reconstitution of blood supply of the denuded bronchial stump. Ann Thorac Surg 2005; 80: 2063-2069
  CrossrefPubMedGoogle Scholar
• 12 Carbognani P, Corradi A, Bobbio A et al. Histological and immunohistochemical study of the bronchial stump with flap coverage in an animal model. Eur Surg Res 2003; 35: 54-57
  CrossrefPubMedGoogle Scholar
• 13 Lois M, Noppen M. Bronchopleural fistulas: an overview of the problem with special focus on endoscopic management. Chest 2005; 128: 3955-3965
  CrossrefPubMedGoogle Scholar
• 14 Zaheer S, Allen MS, Cassivi SD et al. Postpneumonectomy empyema: results after the Clagett procedure. Ann Thorac Surg 2006; 82: 279-286
  CrossrefPubMedGoogle Scholar
• 15 van Berkel V, Guthrie TJ, Puri V et al. Impact of anastomotic techniques on airway complications after lung transplant. Ann Thorac Surg 2011; 92: 316-320
  CrossrefPubMedGoogle Scholar
• 16 Ludwig C, Riedel R, Schnell J et al. Inhalation with Tobramycin to improve healing of tracheobronchial reconstruction. Eur J Cardiothorac Surg 2009; 35: 797-800
  CrossrefPubMedGoogle Scholar
• 17 Sabanathan S, Richardson J. Management of postpneumonectomy bronchopleural fistulae. A review. J Cardiovasc Surg (Torino) 1994; 35: 449-457
  PubMedGoogle Scholar
• 18 Kawashima O, Kamiyoshihara M, Sakata S et al. Comparison of two automatic staplers for closing the bronchial stump after pulmonary resection. Scand Cardiovasc J 2000; 34: 87-89
  CrossrefPubMedGoogle Scholar
• 19 Kopec SE, Irwin RS, Umali-Torres CB et al. The postpneumonectomy state. Chest 1998; 114: 1158-1184
  CrossrefPubMedGoogle Scholar