Der Pneumothorax - Behandlung und Ergebnisse

 

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Zusammenfassung

Die videoassistierte thorakoskopische Chirurgie ist das Standardverfahren zur Versorgung des Pneumothorax geworden. Technische Fortschritte bei Kamera und Optik ermöglichen in Kombination mit endoskopischen Staplergeräten eine minimalinvasive Versorgung sowohl des primären als auch sekundären Pneumothorax. Die Differenzierung dieser zwei Formen gelingt zumeist präoperativ mittels HR-CT. Die Kombination aus Blasenresektion und partieller Pleurektomie bewirkt Rezidivraten unter 4 % und verkürzen nicht nur den Krankenhausaufenthalt, sondern minimieren auch die postoperativen Schmerzzustände. Solange keine professionelle Indikation (Musiker, Pilot, Taucher) vorliegt, behandeln wir das Erstereignis beim primären Spontanpneumothorax mit einer Thoraxdrainage und operieren erst beim Wiederauftreten.

Abstract

Thoracoscopy for the treatment of pneumothorax is the standard procedure in these days. Development of high resolution optics in combination with endoscopic stapler tools advanced to the minimal-invasive treatment of the primary and secondary pneumothorax. For differentiation of these two entities preoperative HR-CT scan is sufficient. The combination of bulla-resection and costal pleurectomy has recurrences in 4 %, trunk the hospital stay and minimise the postoperative pain. As long as the patient has no high risk activities (musicians, pilot, diver etc.), we treat the first pneumothorax with drains and perform surgery on recurrences.

Literatur

• 1 Passlick B, Born C, Häussinger K, Thetter O. Efficiency of video-assisted thoracic surgery (VATS) for primary and secondary spontaneous pneumothorax.  Ann Thorac Surg. 1998;  65 324-327
  CrossrefPubMedGoogle Scholar
• 2 Melton L J, Hepper N G, Offord K P. Incidence of spontaneous pneumothorax in Olmsted County, Minnesota: 1950 to 1974.  Am Rev Respir Dis. 1979;  120 1379-1382
  PubMedGoogle Scholar
• 3 Noppen M, Verbanck S, Harvey J. et al . Music: a new cause of primary spontaneous pneumothorax.  Thorax. 2004;  59 722-724
  CrossrefPubMedGoogle Scholar
• 4 Alifano M, Roth T, Broet C. et al . Catamenial pneumothorax.  Chest. 2003;  124 1004-1008
  CrossrefPubMedGoogle Scholar
• 5 Baumann M H, Strange C, Heffner J E. et al. AACP Pneumothorax Consensus Group . Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement.  Chest. 2001;  119 590-602
  CrossrefPubMedGoogle Scholar
• 6 Bense L, Eklund G, Wiman L G. Smoking and the increased risk of contracting spontaneous pneumothorax.  Chest. 1987;  92 1009-1012
  CrossrefPubMedGoogle Scholar
• 7 Saji H, Nakamura H, Tsuchida T. et al . The incidence and the risk of pneumothorax and chest tube placement after percutaneus CT-guided lung biopsy.  Chest. 2002;  121 1521-1526
  CrossrefPubMedGoogle Scholar
• 8 Schoenenberger R A, Haefeli W E, Weiss P, Ritz R. Evaluation of conventional chest tube therapy for iatrogenic pneumothorax.  Chest. 1993;  104 1770-1772
  CrossrefPubMedGoogle Scholar
• 9 Engdahl O, Toft T, Boe J. Chest radiograph - a poor method for determining the size of a pneumothorax.  Chest. 1993;  103 26-29
  CrossrefPubMedGoogle Scholar
• 10 Bradley M, Williams C, Walshaw M J. The value of routine expiratory chest films in the diagnosis of pneumothorax.  Arch Emerg Med. 1991;  8 115-116
  PubMedGoogle Scholar
• 11 Warner B W, Bailey W W, Shipley R T. Value of computed tomography of the lung in the management of primary spontaneous pneumothorax.  Am J Surg. 1991;  162 39-42
  CrossrefPubMedGoogle Scholar
• 12 Mitlehner W, Friedrich M, Dissmann W. Value of computer tomography in the detection of bullae and blebs in patients with primary spontaneous pneumothorax.  Respiration. 1992;  59 221-227
  CrossrefPubMedGoogle Scholar
• 13 Sahn S A, Heffner J E. Spontaneous pneumothorax.  N Engl J Med. 2000;  342 868-874
  CrossrefPubMedGoogle Scholar
• 14 Crisci R, Coloni G F. Video-assisted thoracoscopic surgery versus thoracotomy for recurrent spontaneous pneumothorax. A comparison of results and costs.  Eur J Cardiothorac Surg. 1996;  10 556-560
  CrossrefPubMedGoogle Scholar
• 15 Andrivet P, Djedaini K, Teboul J L, Brochard L, Dreyfuss D. Spontaneous pneumothorax. Comparison of thoracic drainage vs. immediate or delayed needle aspiration.  Chest. 1995;  108 335-339
  PubMedGoogle Scholar
• 16 Schramel F M, Postmus P E, Vanderschueren R G. Current aspects of spontaneous pneumothorax.  Eur Respir J. 1997;  10 1372-1379
  CrossrefPubMedGoogle Scholar
• 17 Fackeldey V, Schoneich R, Otto A. et al . Structural anomalies in lung apices after pneumothorax operation.  Chirurg. 2002;  73 348-352
  CrossrefPubMedGoogle Scholar
• 18 Conces D J, Tarver R D, Gray W C, Pearcy E A. Treatment of pneumothoraces utilizing small caliber chest tubes.  Chest. 1988;  94 55-57
  CrossrefPubMedGoogle Scholar
• 19 Schoenenberger R A, Haefeli W E, Weiss P, Ritz R F. Timing of invasive procedures in therapy for primary and secondary spontaneous pneumothorax.  Arch Surg. 1991;  126 764-766
  CrossrefPubMedGoogle Scholar
• 20 Rivo Vazquez J E, Canizares Carretero M A, Garcia Fontan E, Albort Ventura J, Penalver Pascual R. Surgical treatment of recurrent spontaneous pneumothorax: what is the optimal timing?.  Arch Bronconeumol. 2004;  40 275-278
  CrossrefPubMedGoogle Scholar
• 21 Alfageme I, Moreno L, Huertas C, Vargas A, Hernandez J, Beiztegui A. Spontaneous pneumothorax. Long-term results with tetracycline pleurodesis.  Chest. 1994;  106 347-350
  PubMedGoogle Scholar
• 22 Chen J S, Hsu H H, Kuo S W, Tsai P R, Chen R J, Lee J M, Lee Y C. Effects of additional minocycline pleurodesis after thoracoscopic procedures for primary spontaneous pneumothorax.  Chest. 2004;  125 50-55
  CrossrefPubMedGoogle Scholar
• 23 Tschopp J M, Bolliger C T, Boutin C. Treatment of spontaneous pneumothorax: why not simple talc pleurodesis by medical thoracoscopy?.  Respiration. 2000;  67 108-111
  CrossrefPubMedGoogle Scholar
• 24 Tschopp J M, Boutin C, Astoul P. Talcage by medical thoracoscopy for primary spontaneous pneumothorax is more cost-effective than drainage: a randomised study.  Eur Respir J. 2002;  20 1003-1009
  CrossrefPubMedGoogle Scholar
• 25 Massard G, Thomas P, Wihlm J M. Minimally invasive management for first and recurrent pneumothorax.  Ann Thorac Surg. 1998;  66 592-599
  CrossrefPubMedGoogle Scholar
• 26 Janssen J P, Schramel F M, Sutedja T G, Cuesta M A, Postmus P E. Videothoracoscopic appearance of first and recurrent pneumothorax.  Chest. 1995;  108 330-334
  CrossrefPubMedGoogle Scholar
• 27 Sawada S, Watanabe Y, Moriyama S. Video-assisted thoracoscopic surgery for primary spontaneous pneumothorax: evaluation of indications and long-term outcome compared with conservative treatment and open thoracotomy.  Chest. 2005;  127 2226-2230
  CrossrefPubMedGoogle Scholar
• 28 Jacobaeus H C. Über die Möglichkeit die Zystoskopie bei Untersuchung seröser Höhlen anzuwenden.  Muench Med Wochenschr. 1910;  40 2090-2092
  PubMedGoogle Scholar
• 29 Dernevik L, Radberg G, Belboul A. Easy pleurectomy with winding up of pleural flaps.  Eur J Cardiothorac Surg. 1999;  16 480-481
  CrossrefPubMedGoogle Scholar
• 30 Czerny M, Salat A, Fleck T. et al . Lung wedge resection improves outcome in stage I primary spontaneous pneumothorax.  Ann Thorac Surg. 2004;  77 1802-1805
  CrossrefPubMedGoogle Scholar
• 31 Vanderschueren R G. The role of thoracoscopy in the evaluation and management of pneumothorax.  Lung. 1990;  168 (Suppl) 1122-1125
  CrossrefPubMedGoogle Scholar
• 32 Bernard A, Belichard C, Goudet P, Lombard J N, Viard H. Spontaneous pneumothorax. A comparison of thoracoscopy and thoracotomy.  Rev Mal Respir. 1993;  10 433-436
  PubMedGoogle Scholar
• 33 Naunheim K S, Mack M J, Hazelrigg S R. et al . Safety and efficacy of video-assisted thoracic surgical techniques for the treatment of spontaneous pneumothorax.  J Thorac Cardiovasc Surg. 1995;  109 1198-1203
  CrossrefPubMedGoogle Scholar
• 34 Leschber G, Kaiser D, Betzler M. Thorakoskopische Behandlung des Spontanpneumothorax. BDC Akademie. Springer, Berlin, Heidelberg 1996; 10-12
  Google Scholar
• 35 Hurtgen M, Linder A, Friedel G, Toomes H. Video-assisted thoracoscopic pleurodesis. A survey conducted by the German Society for Thoracic Surgery.  Thorac Cardiovasc Surg. 1996;  44 199-203
  PubMedGoogle Scholar
• 36 Horio H, Nomori H, Fuyuno G, Kobayashi R, Suemasu K. Limited axillary thoracotomy vs video-assisted thoracoscopic surgery for spontaneous pneumothorax.  Surg Endosc. 1998;  12 1155-1158
  CrossrefPubMedGoogle Scholar
• 37 Passlick B, Born C, Sienel W, Thetter O. Incidence of chronic pain after minimal-invasive surgery for spontaneous pneumothorax.  Eur J Cardiothorac Surg. 2001;  19 355-358
  CrossrefPubMedGoogle Scholar
• 38 Sihoe A D, Au S S, Cheung M L. et al . Incidence of chest wall paresthesia after video-assisted thoracic surgery for primary spontaneous pneumothorax.  Eur J Cardiothorac Surg. 2004;  25 1054-1058
  CrossrefPubMedGoogle Scholar
• 39 Lardinois D, Vogt P, Yang L, Hegyi I, Baslam M, Weder W. Non-steroidal anti-inflammatory drugs decrease the quality of pleurodesis after mechanical pleural abrasion.  Eur J Cardiothorac Surg. 2004;  25 865-871
  CrossrefPubMedGoogle Scholar
• 40 Passlick B, Born C, Mandelkow H, Sienel W, Thetter O. Long-term complaints after minimal invasive thoracic surgery operations and thoracotomy.  Chirurg. 2001;  72 934-938
  CrossrefPubMedGoogle Scholar
• 41 Bertrand P C, Regnard J F, Spaggiari L. et al . Immediate and long-term results after surgical treatment of primary spontaneous pneumothorax by VATS.  Ann Thorac Surg. 1996;  61 1641-1645
  CrossrefPubMedGoogle Scholar
• 42 Lee P, Yap W S, Pek W Y, Ng A W. An audit of medical thoracoscopy and talc poudrage for pneumothorax prevention in advanced COPD.  Chest. 2004;  125 1315-1320
  CrossrefPubMedGoogle Scholar
• 43 Hatz R A, Kaps M F, Meimarakis G, Loehe F, Muller C, Furst H. Long-term results after video-assisted thoracoscopic surgery for first-time and recurrent spontaneous pneumothorax.  Ann Thorac Surg. 2000;  70 253-257
  CrossrefPubMedGoogle Scholar
• 44 Korner H, Andersen K S, Stangeland L, Ellingsen I, Engedal H. Surgical treatment of spontaneous pneumothorax by wedge resection without pleurodesis or pleurectomy.  Eu J Cardiothorac Surg. 1996;  10 656-659
  PubMedGoogle Scholar
• 45 Horio H, Nomori H, Kobayashi R, Naruke T, Suemasu K. Impact of additional pleurodesis in video-assisted thoracoscopic bullectomy for primary spontaneous pneumothorax.  Surg Endosc. 2002;  16 630-634
  CrossrefPubMedGoogle Scholar

Dr. med. univ. Michael Lindner

Klinik für Thoraxchirurgie · Zentrum für Pneumologie und Thoraxchirurgie · Asklepios-Fachkliniken München-Gauting

Robert-Koch-Allee 2

82131 Gauting

Email: m.lindner@asklepios.com