Die endoskopische Therapie der Tumorobstruktion des Tracheobronchialsystems: eine Gegenüberstellung verfügbarer Techniken

Zusammenfassung

Die zentrale Atemwegsstenose ist eine häufige Komplikation bei Tumorerkrankungen der Lunge. Symptomatische Stenosen können endoskopisch häufig erfolgreich beseitigt werden. Hierzu stehen mehrere Verfahren mit unterschiedlichen Therapieansätzen zur Verfügung. Die Behandlung exophytischer Tumorstenosen zielt darauf ab, das in das Lumen ragende Tumorgewebe zu entfernen. Dabei sind Rekanalisationsverfahren mit Soforteffekt (mechanische Abtragung, Elektrochirurgie, Argon-Plasma-Koagulation, Laser, Kryoextraktion) von Techniken mit verzögerter Wirkung (Kryotherapie, Brachytherapie, photodynamische Therapie) zu unterscheiden. Stenosen, die durch Kompression von außen entstehen, können durch die Implantation von Silikonstents oder selbstexpandierenden Metallstents wiedereröffnet werden.

Abstract

Malignant central airway obstruction is a common problem in lung cancer. A symptomatic stenosis can often be treated successfully using endoscopy. Different approaches for recanalisation are available. The goal of treating exophytic obstruction is to remove the endobronchial tumour growth. Mechanic debulking, electrocautery/diathermy, argon plasma coagulation, laser resection and cryoextraction are techniques that can provide immediate relief. Cryotherapy, brachytherapy and photodynamic therapy show delayed recanalisation effects. Silicone or self-expanding metallic airway stents can be used for the treatment of airway obstruction due to extrinsic disease to restore and maintain airway patency.

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