Pneumologie 2005; 59(2): 120-135
DOI: 10.1055/s-2004-830201
Serie „Pleuraerkrankungen” (5)
© Georg Thieme Verlag Stuttgart · New York

Management der malignen Pleuraergüsse

Management of Malignant Pleural EffusionsR.  Loddenkemper1
  • 1HELIOS Klinikum Emil von Behring, Lungenklinik Heckeshorn, Zentrum für Pneumologie und Thoraxchirurgie, Berlin
Further Information

Publication History

Publication Date:
21 February 2005 (online)

Zusammenfassung

Maligne Pleuraergüsse mit ihrem Hauptsymptom Atemnot sind ein häufiges Problem bei Patienten mit bösartigen Tumorerkrankungen. Verantwortlich führend ist der Lungenkrebs, gefolgt vom Mammakarzinom und den malignen Lymphomen. Die Häufigkeit des Pleuramesothelioms nimmt in den Industrieländern zu. In dieser Übersicht, die auf dem ERS/ATS-Statement 2001 basiert, werden das diagnostische Vorgehen, die Differenzialdiagnostik - einschließlich der Ursachen paramaligner Pleuraergüsse - und die therapeutischen Möglichkeiten aufgezeigt. Bei den lokalen Maßnahmen steht die Pleurodese im Vordergrund, heute vorzugsweise mittels thorakoskopischer Talkum-Puderung. Alternative lokale und systemische Behandlungsmöglichkeiten werden eingehend besprochen. Speziell wird auf die Epidemiologie, Diagnostik, Therapie und Prognose beim Lungenkarzinom, beim Mammakarzinom und bei den malignen Lymphomen eingegangen. Abschließend werden offene Fragen aufgezählt, die der zukünftigen Forschung bedürfen und hoffentlich die Therapie und Prognose der malignen Ergüsse verbessern werden.

Abstract

Malignant pleural effusions with dyspnoea as their most common presenting symptom are a frequent clinical problem in patients with neoplastic disease. Lung carcinoma is the leading cause, followed by breast carcinoma and malignant lymphoma. The frequency of malignant mesothelioma is increasing in industrialized countries. In this overview, which is based on the ERS/ATS Statement 2001, the diagnostic approach, the differential diagnosis including causes of paramalignant effusions, as well as the therapeutic possibilities are described. Pleurodesis is the most important therapeutic modality, today preferably via thoracoscopic talc poudrage. Alternative local and systemic treatment options are discussed in detail. A special emphasis is put on the epidemiology, diagnosis, treatment, and prognosis of malignant effusions in patients with lung and breast carcinomas, and with lymphomas. Finally, open questions are listed which need future research, which will hopefully improve the treatment and prognosis of malignant pleural effusions.

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Bereits publizierte Beiträge zu dieser Serie:

Prof. Dr. med. R. Loddenkemper

HELIOS Klinikum Emil von Behring · Lungenklinik Heckeshorn · Zentrum für Pneumologie und Thoraxchirugie

Zum Heckeshorn 33

14109 Berlin

Email: loddheck@zedat.fu-berlin.de