Pleuraempyem – Behandlungsstrategien unter Berücksichtigung der Ätiologie

Zusammenfassung

Die Vielfältigkeit der Prinzipien in der Behandlung des parapneumonischen Pleuraempyems zeugt von der bis heute bestehenden Unklarheit über den korrekten Verfahrensweg zum jeweiligen Zeitpunkt – Identisches gilt für die Behandlung des Pleuraempyems im Rahmen von operativen Eingriffen. Das parapneumonische Pleuraempyem wurde von verschiedenen amerikanischen Fachgesellschaften unter unterschiedlichen Aspekten klassifiziert: Einteilung nach der natürlichen Verlaufsform bzw. nach der Zusammensetzung des Ergusses (American Thoracic Society – ATS), Einteilung nach der Risikowahrscheinlichkeit für ein schlechtes Behandlungsergebnis (American College of Chest Physicians – ACCP), oder es wurden Behandlungsalgorithmen empfohlen, basierend auf einer systematischen Analyse ausgewählter Literatur (British Thoracic Society – BTS). Die Behandlungsstrategie des parapneumonischen Pleuraempyems, aber auch des Empyems im Rahmen von Operationen sollte adaptiert an das jeweilige Stadium erfolgen. Das Behandlungsspektrum umfasst die alleinige Drainagenbehandlung, die Drainagentherapie mit Fibrinolytika, das thorakoskopische Débridement, die geschlossene Empyemektomie per VATS oder offenchirurgisch, die Dekortikation in offener bzw. minimalinvasiver Technik sowie die Behandlung mittels Thoraxfensteranlage, Thorakomyoplastik bzw. die Vakuumversiegelung mit Unterdrucktherapie. Die Vielfältigkeit der Behandlungsoptionen aus konservativen und operativen Methoden bedingt den zentralen Stellenwert der Thoraxchirurgie.

Abstract

The variety of strategies in the treatment of parapneumonic pleural empyema demonstrates the ambiguity for the method of choice. Parapneumonic pleural empyema has been classified into different stages and classes. While the American Thoracic Society (ATS) classification is based on the natural course of the disease, or according to the radiological, physical and biochemical characteristics respectively, the American College of Chest Physicians (ACCP) has categorized the patients with pleural empyema according to the risk of a poor outcome. The British Thoracic Society (BTS) developed a treatment algorithm based on a systematic review of peer-reviewed literature. With regard to this classification the management of parapneumonic and postoperative pleural empyema is based on the stage of the disease. Therapeutic strategies include chest tube alone, chest tube with fibrinolysis, thoracoscopic debridement and decortication in open or minimally invasive techniques, closed empyemectomy, or treatment with thoracomyoplasty, open window treatment or vacuum clothing with negative pressure. The different conservative and operative therapeutic possibilities determinate the central treatment function of thoracic surgery.

Key words

Pleuraempyem - Pyothorax - Thoraxchirurgie - OP-Komplikation - Infektion der Pleurahöhle

Key words

pleural empyema - pyothorax - thoracic surgery - postoperative complications - infection of the pleural cavity

• Zum Weiterlesen und Vertiefen

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