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Zentralbl Chir 2012; 137(3): 214-222
DOI: 10.1055/s-0031-1284013
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Pneumothorax, welche Therapie ist notwendig? Ein klinischer Überblick

Pneumothorax, What Kind of Therapy is Necessary? A Clinical Overview
D. Ghezel-Ahmadi
1   HSK, Dr. Horst Schmidt Klinik, Thoraxchirurgie, Wiesbaden, Deutschland
,
S. Bölükbas
1   HSK, Dr. Horst Schmidt Klinik, Thoraxchirurgie, Wiesbaden, Deutschland
,
T. Fischer
1   HSK, Dr. Horst Schmidt Klinik, Thoraxchirurgie, Wiesbaden, Deutschland
,
V. Ghezel-Ahmadi
2   HSK, Dr. Horst Schmidt Klinik, Anästhesie, Wiesbaden, Deutschland
,
J. Schirren
1   HSK, Dr. Horst Schmidt Klinik, Thoraxchirurgie, Wiesbaden, Deutschland
› Author Affiliations
Further Information

Publication History

Publication Date:
18 June 2012 (online)

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Zusammenfassung

Ein Pneumothorax ist definiert, als eine Luftansammlung im Pleuraspalt. Man unterscheidet zunächst zwischen einem primären idiopathischem (PSP) und einem sekundären Spontanpneumothorax (SSP). Weiterhin werden noch der iatrogene und der traumatische Pneumothorax unterschieden. Der PSP tritt ohne erkennbares Trauma und ohne zugrunde zu liegende Lungenerkrankung auf und am häufigsten sind junge, asthenischer Männer betroffen. Der SSP hingegen hat in den meisten Fällen eine manifeste Lungengerüsterkrankung als Ursache und ist bei älteren Patienten ( > 50 Jahre) am häufigsten. Raucher haben ein erhöhtes Risiko, einen Pneumothorax zu entwickeln. Die meisten Pneumothoraces erfordern eine therapeutische Intervention mittels Thoraxdränage und nur ein kleiner Teil der Patienten kann beobachtet werden. Entgegen einiger Therapieempfehlungen zeigte sich in der klinischen Anwendung der einfachen Nadelaspiration kein Behandlungsvorteil. Alle Patienten mit einem symptomatischen Pneumothorax müssen mit einer schnellstmöglich eingelegten Thoraxdränage in den Pleuraspalt therapiert werden. In der operativen Behandlung des Pneumothorax gehört die VATS zur derzeitigen Standardtherapie und nur in Ausnahmefällen und Komplikationen wird die posterolaterale Thorakotomie dem minimalinvasiven Verfahren vorgezogen. Beide Operationen haben die Zielsetzung, die Rezidivrate des Pneumothoraxes möglichst gering zu halten.

Abstract

Pneumothorax is defined as the accumulation of air in the pleural space. A distinction is made between a primary (idiopathic) spontaneous pneumothorax (PSP), secondary spontaneous pneumothorax (SSP) as well as between iatrogenic pneumothorax and traumatic pneumothorax. Primary spontaneous pneumothorax (PSP) occurs mainly in otherwise healthy people (mainly tall and thin young men) without any clinical sign of lung disease. In contrast, secondary pneumothorax (SSP) mostly occurs in patients with diagnosed and clinically manifested lung disease and is most frequent in older subjects ( > 50 years). Smokers have a higher risk of developing pneumothorax. Most pneumothorax cases require a therapeutic intervention using thorax drainage. Observation alone is recommended for only those few patients suffering from pneumothorax without clinical symptoms. Although simple needle aspiration is often recommended as a first-line treatment, our clinical experience shows no advantage for most of the patients. All patients with symptomatic pneumothorax should be treated with immediate intercostal tube drainage. In the surgical therapy of pneumothorax, VATS (video-assisted thoracic surgery) is the current effective standard treatment. Open posterolateral thoracotomy is the recommend approach rather than the minimally invasive procedure in patient with serious illness or complications. The aim of both interventions is to reduce the recurrence rate of pneumothorax as much as possible.

Schlüsselwörter

Pneumothorax - Thoraxdränage - videoassistierte Thorakoskopie - Therapieoptionen - Thoraxchirurgie

Key words

pneumothorax - thoracic drainage - video-assisted thoracoscopic surgery - therapy options - thoracic surgery
 

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