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Zentralbl Chir 2018; 143(03): 290-295
DOI: 10.1055/s-0043-123656
Originalarbeit
Georg Thieme Verlag KG Stuttgart · New York

Effektivität und Sicherheit von getunnelten pleuralen Dauerkathetern

Efficacy and Safety of Indwelling Pleural Catheters
Eva Lücke
1   Universitätsklinik für Pneumologie Magdeburg, Otto-von-Guericke-Universität Magdeburg, Medizinische Fakultät, Deutschland
,
Uwe Steffen
2   Dres. med. U. Steffen und A. Korsch, Pneumologische Gemeinschaftspraxis, Wolfsburg, Deutschland
,
Sandra Riedel
1   Universitätsklinik für Pneumologie Magdeburg, Otto-von-Guericke-Universität Magdeburg, Medizinische Fakultät, Deutschland
,
Jens Schreiber
1   Universitätsklinik für Pneumologie Magdeburg, Otto-von-Guericke-Universität Magdeburg, Medizinische Fakultät, Deutschland
› Author Affiliations
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Publication History

Publication Date:
11 January 2018 (online)

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Zusammenfassung

Bei symptomatischen malignen Pleuraergüssen sollte ein therapeutisches Verfahren gewählt werden, welches die Dyspnoe und die konsekutive Einschränkung der Lebensqualität in der meist palliativen Situation verbessert. Ein dauerhaft implantierter Pleurakatheter (indwelling pleural catheter – IPC) ist eine der aktuell zur Verfügung stehenden Methoden, deren Bedeutung in den letzten Jahren zugenommen hat. Effektivität und Sicherheit dieser Methode sind unter realen klinischen Bedingungen außerhalb von Studien noch unzureichend geklärt. Es wurden die Daten von 94 Patienten, die aus klinischer Indikation mit einem IPC versorgt wurden, retrospektiv analysiert. Ausgewertet wurden neben Sicherheit und Effektivität die Patientencharakteristika, peri- und postinterventionelle Komplikationen, wie Infektionen oder das Auftreten eines Pneumothorax, und der längerfristige Verlauf mit dem Schwerpunkt der Frage, ob eine Pleurodese eingetreten ist. Insgesamt 89,5% (n = 85) der Patienten erhielten den IPC aufgrund eines rezidivierenden Pleuraergusses bei maligner Grunderkrankung. Die mittlere Krankenhausverweildauer nach Implantation lag für diejenigen Patienten, die nicht noch im Krankenhaus an ihrer infausten Erkrankung verstorben sind, bei 3,29 Tagen. Bei 21,2% (n = 20) der Patienten kam es zu einer Pleurodese. Methodenbedingte Komplikationen traten bei 33,7% (n = 32) der Patienten auf, lediglich bei 8 Patienten gab es jedoch weiteren Handlungsbedarf. Spätkomplikationen sind bei 9 Patienten aufgetreten. Die mittlere Überlebenszeit nach Implantation lag bei durchschnittlich 88,72 Tagen. Zusammenfassend zeigen die Daten, dass der IPC eine technisch einfach durchführbare, minimalinvasive Alternative zu rezidivierenden Punktionen oder anderen Pleurodeseverfahren ist. Ein wesentlicher Vorteil ist die ambulante Versorgungsmöglichkeit.

Abstract

In symptomatic malignant pleural effusions, mostly in a palliative situation, therapeutic procedures should be chosen to improve dyspnoea and the concomitant impairment of quality of life. Indwelling pleural catheters (IPC) have played an increasing role in recent years. The efficacy and safety of this method have not been adequately clarified under real-life clinical conditions. 94 patients, in whom IPC had been implanted because of a clinical indication, were analysed retrospectively with respect to efficacy and safety, together with patient characteristics, peri- and postinterventional complications, e.g. infections or pneumothorax, and long-term follow-up – with special emphasis on the occurrence of a pleurodesis. Overall, 89.5% (n = 85) of the patients received an IPC due to a recurrent pleural effusion caused by a malignant primary disease. The average duration of hospitalisation for patients did not decease as a result of their incurable condition and was 3.29 days. In 21.2% (n = 20) of the patients, pleurodesis occurred. Method-related complications arose for 33.2% (n = 32) of the patients, although further treatment was only needed in 8 patients. Late complications developed for 9 of the patients observed. The average survival period after implantation was 88.72 days. The results show that IPC is a technically straightforward, minimally invasive alternative to recurrent punctures or other methods of pleurodesis. A major benefit is the possibility of outpatient care.

Schlüsselwörter

Pleurodese - maligner Pleuraerguss - dauerhaft getunnelter Pleurakatheter - videoassistierte Thorakoskopie

Key words

pleurodesis - malignant pleural effusion - indwelling pleural catheter - video assisted thoracoscopy
 

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