Das Management des malignen Pleuraergusses beinhaltet eine frühzeitige Diagnostik,
zu der die zytopathologische Beurteilung sowie die Evaluation der Ausdehnungsfähigkeit
der Lunge nach Drainage des MPE zählt. Die therapeutischen Verfahren zur lokalen Ergusskontrolle
entsprechen palliativen Maßnahmen zur Linderung der Symptome und sollten differenziert
nach dem Allgemeinzustand sowie Prognoseabschätzung des Patienten angewendet werden.
Abstract
Malignant pleural effusion is a common diagnosis in metastasized cancers. It is always
of palliative character. Main symptoms are dyspnoea and reduced quality of life. Diagnosis
is made by ultrasound-guided puncture of the pleural effusion (cytology) and often
video-assisted thoracic surgery with biopsy of the pleural surface (histology). The
goal of treatment is a fast, sustainable, minimally invasive, patient-centred therapy
that increases quality of life. Besides systemic therapy and best supportive care
the patient can be treated with local therapy including either pleurodesis (via drainage
or VATS) or an indwelling-pleural catheter (IPC). Decision for one of these procedures
is made upon performance index (ECOG), expandability of the lung, prognosis and the
patient’s wish. For the first technique, the lung must be expandable. The latter one
(IPC) can be implanted both with expandable and trapped lung. Both are similarly effective
in symptom control.
Schlüsselwörter
maligner Pleuraerguss - Pleurakarzinose - Pleurodese - Pleurakatheter
Keywords
malignant pleural effusion - pleural carcinosis - pleurodesis - indwelling pleural
catheter
