Stadienadaptierte moderne Therapie des Pleuraempyems

Zusammenfassung

Auch im Zeitalter der modernen Antibiotikatherapie stellt das Pleuraempyem nach wie vor eine ernste thorakale Erkrankung dar, die mit einer hohen Morbidität und Letalität assoziiert ist. Aufgrund unspezifischer Beschwerden der Erkrankung werden Patienten häufig erst verzögert ­einer adäquaten Diagnostik zugeführt. Eine frühzeitige ausführliche Diagnostik bei Patienten mit klinischem Verdacht auf ein Pleuraempyem stellt eine notwendige Voraussetzung einer effektiven stadiengerechten Therapie dar. Das chirurgische Therapiespektrum reicht von einer einfachen Dränagenanlage über minimalinvasive thorakoskopische Behandlungsoptionen bis hin zur klas­sischen offenen Dekortikation. Darüber hinaus werden die Behandlungsmöglichkeiten heute durch interventionelle, CT-gesteuerte Therapieverfahren ergänzt. Die optimale Therapiestrategie muss individuell unter Berücksichtigung des Allgemeinzustandes des Patienten, dem Erkrankungsstadium sowie der Ätiologie festgelegt werden und sollte in thoraxchirurgisch spezialisierten Abteilungen erfolgen. 

Abstract

In spite of the development and widespread avail­ability of modern antibiotics, pleural empyema still represents a serious intrathoracic disease ­associated with significant morbidity and mor­tality. Patients with complicated parapneumonic effusions and empyema have an increased mor­bidity and mortality due at least in part to inappropriate and delayed management of pleural space infections. Timely diagnosis of pleural empyema and rapid initiation of the appropriate surgical treatment modality represent keystone principles for efficient treatment of thoracic ­empyema. Simple drainage, minimally invasive surgical treatment modalities (VATS) and image-guided small-bore catheters in combination with adjunctive fibrinolytic drugs have extended the potential therapeutic arsenal. Individual case man­agement with a flexible selection of the most appropriate treatment modality by experienced thoracic surgeons may lead to improved outcomes. In this context a summary of the most recent opinions and results in thoracic empyema management is outlined in the present review. 

Schlüsselwörter

Infektion - Thorakoskopie - Thorakotomie - Pleuraempyem

Key words

infection - thoracoscopy - thoracotomy - pleural empyema

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