Chirurgische Therapie des malignen Pleuraergusses

Zusammenfassung

Der maligne symptomatische Pleuraerguss ist eine häufige Komplikation bösartiger Erkrankungen (ca. 50 %). Das Auftreten ist ein Zeichen der Progredienz der Erkrankung. Die betroffenen Patienten haben eine mittlere Lebenserwartung von 3-12 Monaten. Ziel der Behandlung ist es, den Patienten eine schnelle und effiziente Therapie mit einem kurzen Krankenhausaufenthalt anzubieten. Mittels einer Thoraxdrainage wird der Pleuraerguss entlastet und die Entfaltung der Lunge festgestellt. Sofern dies geschehen ist, wird zur Verklebung der Pleura die thoraskopische Talkumpleurodese empfohlen. Talkum (Erfolgsrate > 80 %) ist das Mittel 1. Wahl, gefolgt von Doxycyclin (70 %). Diese Methode ist komplikationsträchtiger als eine einfache Pleurodese über die bereits liegende Drainage, hat aber die höchste Erfolgsrate. Weitere Möglichkeiten sind Thoraxdauerdrainagen und der pleuroperitoneale Shunt bei Patienten mit sehr reduziertem Allgemeinzustand und / oder gefesselter Lunge.

Abstract

Symptomatic malignant pleural effusions are common in patients with neoplastic disease (50 %). Frequently, they are a sign of advanced disease. These patients have an average life expectancy of 3 to 12 months. The therapeutic aim should be an efficient treatment with a short hospital stay. Chest tube drainage gives rapid relief of symptoms and information on the expansion of the lungs. When complete expansion of the lung is possible, VATS insufflation of talc is recommended. Talc is the most effective sclerosant (80 %) followed by doxycycline (70 %). VATS pleurodesis has a higher complication rate but is more effective than a talc slurry instilled through the chest tube. When the lung is trapped, long-term indwelling pleural drainage and pleuroperitoneal shunts are alternatives.

maligner Pleuraerguss - VATS - Talkumpleurodese

malignant pleural effusions - VATS - talc pleurodesis

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