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Zentralbl Chir 2017; 142(S 01): S53-S65
DOI: 10.1055/s-0043-109257
CME-Fortbildung
Georg Thieme Verlag KG Stuttgart · New York

Interdisziplinäre Therapie der Lungentuberkulose

Interdisciplinary Treatment of Patients with Pulmonary Tuberculosis
Joachim Pfannschmidt
,
Nicolas Schönfeld
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Publikationsverlauf

Publikationsdatum:
04. Oktober 2017 (online)

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Zusammenfassung

Die chirurgische Therapie der Lungentuberkulose war seit der breiten Verfügbarkeit effektiver Antibiotika nur noch in seltenen Fällen indiziert. Die zunehmende Problematik multiresistenter Tuberkulosestämme in den letzten 2 Jahrzehnten hat die Bedeutung chirurgischer Therapieverfahren jedoch erneut in den Fokus gerückt. Ziel dieser Arbeit ist die Darstellung der wesentlichen Indikationskriterien zur chirurgischen Behandlung im interdisziplinären Konzept mit den heutigen Möglichkeiten der tuberkulostatischen Therapie.

Abstract

Today surgical procedures for pulmonary tuberculosis are highly selective but owing to the increasing incidence of multidrug resistant tuberculosis has been becoming more and more relevant. Besides the treatment of tuberculosis foci in multidrug resistance tuberculosis to eliminate the source of relapse, complications as sequelae of tuberculosis are among the most frequent indications for surgery. In patients with cavernous lesions, destroyed lobe or lung, bronchiectasis, pleural empyema or hemoptysis thoracic surgical procedures may be warranted. However, in solitary pulmonary nodules operations with diagnostic purpose are necessary, not only to rule out a potential malignancy, but also to identify a so far unidentified tuberculoma. Considering the heterogenous group of patients with tuberculosis, surgical morbidity and mortality are in the known range for surgical resections in lung cancer patients.

Kernaussagen

  • In der Behandlung der Lungentuberkulose hat die chirurgische Therapie eine hohe Bedeutung, vor allem in der Therapie der Tuberkulosefolgeerkrankungen, akuter Komplikationen und zur Fokussanierung bei MDR-/XDR-Tuberkulose (MDR = Multidrug-resistant Tuberculosis; XDR = Extensively Drug-resistant Tuberculosis).

  • Thoraxchirurgen sollten mit interdisziplinären Behandlungskonzepten der Tuberkulose vertraut sein und moderne parenchymsparende Operationsverfahren beherrschen.

  • Eine besondere operative Expertise ist bei ausgedehnten Resektionen, vor allem bei „Destroyed Lobe/Lung“ und begleitender Aspergillose notwendig.

Schlüsselwörter

Tuberkulose - spezifisches Empyem - Bronchiektase - Hämoptyse

Key words

tuberculosis - specific empyema - bronchiectasis - hemoptysis
 

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