Radiologische Aspekte der Lungenvolumenreduktionschirurgie

Zusammenfassung

Wenn die konservative Therapie einer COPD mit Lungenemphysem ausgereizt ist und eine Lungentransplantation nicht infrage kommt, kann eine Reduktion des Lungenvolumens der nächste Therapieschritt sein. Lungenvolumenreduktionschirurgie (Lung Volume Reduction Surgery, LVRS) verwendet unterschiedliche Techniken, u. a. das sog. „apikale Shaving“, die gezielte Resektion einer Targetzone und die vollständige Lappenresektion. Neben diesen LVRS-Techniken besteht die Möglichkeit einer minimalinvasiven, bronchoskopisch geführten Therapie mit Einbahnstraßenventilen, endobronchialen Coils oder Wasserdampfablation. Allen chirurgischen und bronchoskopischen Verfahren gemein ist die Notwendigkeit einer kritischen Patientenselektion und einer aussagekräftigen radiologischen Diagnostik zur Therapieplanung. Dazu gehören die Akquise eines computertomografischen Volumendatensatzes der Lunge, die softwareunterstützte Quantifizierung des Emphysemanteils am Lungengewebe und die Beurteilung der Fissurenintegrität. Vor allem bei komplexen Befundkonstellationen können nuklearmedizinische Untersuchungen wertvolle Zusatzinformationen liefern. Die interdisziplinäre Emphysemkonferenz entscheidet dann unter Würdigung sämtlicher Vordiagnostik, welcher Patient welchem Therapieverfahren zugeführt werden soll.

Abstract

In cases where conservative treatment for COPD with emphysema has been unsuccessful and a lung transplant is not a viable option, reducing the lung volume may be the most appropriate therapeutic course of action. Lung volume reduction surgery (LVRS) employs a range of techniques, including apical shaving, targeted resection of a target zone and complete flap resection. In addition to these LVRS techniques, minimally invasive, bronchoscopically guided therapy with one-way valves, endobronchial coils or water vapour ablation is also a possibility. All surgical and bronchoscopic procedures have one thing in common: they all require critical patient selection and meaningful radiological diagnostics for treatment planning. This encompasses the acquisition of a data set for computed tomography of the lung, the software-supported quantification of the proportion of empyema in the lung tissue, and the assessment of fissure integrity. Nuclear medicine examinations have been shown to provide valuable additional information, particularly in cases of complex constellations of findings. The interdisciplinary emphysema conference is then convened to determine the most appropriate treatment procedure for each patient, taking into account all preliminary diagnostic findings.

Schlüsselwörter

LVRS - COPD - Lungenemphysem

Keywords

lung emphysema - COPD - LVRS

Publikationsverlauf

Eingereicht: 31. Januar 2025

Angenommen nach Revision: 10. Juli 2025

Artikel online veröffentlicht:
25. August 2025

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