Zusammenfassung
Die präoperative Risikostratifikation vor lungenresezierenden Eingriffen erfordert
die Messung von FEV1 und TLCO. Der Bestimmung der relativen Werte und der prädiktiven postoperativen (ppo)
Werte ist den Absolutwerten der Vorzug zu geben. Nationale und internationale Guidelines
benutzen unterschiedliche Wege in der präoperativen Funktionsdiagnostik. Im Allgemeinen
empfehlen sie die Durchführung der Spiroergometrie, wenn die FEV1 und die TLCO < 80 %-Soll oder ppo-Werte < 40 %-Soll sind. Von Inoperabilität wird
ausgegangen, wenn die ppo-Werte der V'O2-max < 10 ml/kg/min oder < 35 %-Soll sind. Auf der Basis dieser Grenzwerte wird ein
vereinfachter diagnostischer Algorithmus (Hemer-Algorithmus) für die präoperative
Entscheidungsfindung der funktionellen Operabilität dargestellt. Dennoch bleiben offene
Fragen. Diese betreffen zum einen die Bewertung des individuellen operativen Risikos
von Patienten, die sich rechnerisch im oder knapp außerhalb des anerkannten Grenzbereichs
der funktionellen Operabilität befinden; zum anderen den Umgang mit der Tatsache,
dass Patienten trotz der (hoch-)risikobehafteten funktionellen Situation bereit sind,
ein höheres Morbiditäts- und Mortalitätsrisiko in Kauf zu nehmen, insbesondere wenn
ein kurativer Therapieansatz besteht.
Abstract
Preoperative risk stratification for lung surgery requires the determination of FEV1 and TLCO. Calculation of relative values and predective postoperative values in dependence
on the extent of resection is preferable in comparison to absolute values. National
and international guidelines have different recommendations for preoperative functional
assessment. In general they recommend cardiopulmonary exercise testing if preoperative
FEV1 and TLCO are < 80 %-pred. or if ppo values are < 40 %-pred. Inoperability is assumed
if ppo values of V'O2-max are < 10 ml/kg/min or < 35 %-pred. On this basis, a more simplified algorithm
for the preoperative assessment of candidates for lung resection (Hemer algorithm)
is presented. Nevertheless, there still remain some unresolved questions. These concern
the assessment of the individual operative risk of patients who are at or just beyond
the limits of functional operability. Furthermore, there is the fact that patients
- in spite of a severe functional impairment - are willing to accept a higher risk
of morbidity and mortality, especially if there is a curative option.
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M. Westhoff
Klinik für Pneumologie, Allergologie, Schlaf- und Beatmungsmedizin (Chefarzt PD Dr.
L. Freitag), Lungenklinik Hemer
Theo-Funccius-Str. 1
58675 Hemer
Email: michael.westhoff@lkhemer.de
