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Allgemein- und Viszeralchirurgie up2date 2024; 18(06): 537-551
DOI: 10.1055/a-2367-3446
Allgemeine Chirurgie

Management des malignen Pleuraergusses

Management of Malignant Pleural Effusion
Christopher Larisch
,
Julia Riedel
,
Hans-Stefan Hofmann
,
Michael Ried 
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Das Management des malignen Pleuraergusses beinhaltet eine frühzeitige Diagnostik, zu der die zytopathologische Beurteilung sowie die Evaluation der Ausdehnungsfähigkeit der Lunge nach Drainage des MPE zählt. Die therapeutischen Verfahren zur lokalen Ergusskontrolle entsprechen palliativen Maßnahmen zur Linderung der Symptome und sollten differenziert nach dem Allgemeinzustand sowie Prognoseabschätzung des Patienten angewendet werden.

Abstract

Malignant pleural effusion is a common diagnosis in metastasized cancers. It is always of palliative character. Main symptoms are dyspnoea and reduced quality of life. Diagnosis is made by ultrasound-guided puncture of the pleural effusion (cytology) and often video-assisted thoracic surgery with biopsy of the pleural surface (histology). The goal of treatment is a fast, sustainable, minimally invasive, patient-centred therapy that increases quality of life. Besides systemic therapy and best supportive care the patient can be treated with local therapy including either pleurodesis (via drainage or VATS) or an indwelling-pleural catheter (IPC). Decision for one of these procedures is made upon performance index (ECOG), expandability of the lung, prognosis and the patient’s wish. For the first technique, the lung must be expandable. The latter one (IPC) can be implanted both with expandable and trapped lung. Both are similarly effective in symptom control.

Kernaussagen

  • Primäres Ziel beim Management des MPE besteht darin, die Symptomatik schnell, nachhaltig, schonend/minimalinvasiv und mit kurzer Hospitalisierung zu kontrollieren.

  • Das therapeutische Lokalverfahren sollte individuell abhängig vom Allgemeinzustand des Patienten, von der Ausdehnungsfähigkeit der Lunge, der Prognose und vor allem abhängig vom Patientenwunsch ausgewählt werden.

  • Eine erfolgreiche Pleurodese kann via Drainage, VATS oder IPC unter stationären wie ambulanten Bedingungen erfolgen, setzt jedoch eine möglichst erhaltene Ausdehnungsfähigkeit der Lunge voraus.

  • Bei symptomatischen Patienten und fehlender Ausdehnungsfähigkeit der Lunge („Trapped Lung“) sollte der IPC zur Ergusskontrolle favorisiert werden.

  • Sowohl die Pleurodese als auch der IPC sind effektive Verfahren zur Besserung der Symptomatik und der Lebensqualität der Patienten mit MPE.

Schlüsselwörter

maligner Pleuraerguss - Pleurakarzinose - Pleurodese - Pleurakatheter

Keywords

malignant pleural effusion - pleural carcinosis - pleurodesis - indwelling pleural catheter


Publication History

Article published online:
02 December 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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