Emphysemchirurgie – State of the Art 2016

Zusammenfassung

Bereits Mitte der 90er-Jahre konnte in großen Fallserien gezeigt werden, dass die chirurgische Lungenvolumenreduktion (LVRS) bei Patienten mit fortgeschrittenem Lungenemphysem die Atemnot verringert und die Lungenfunktion und Lebensqualität verbessert. Mit dem National Emphysema Treatment Trial (NETT) Anfang der 2000er-Jahre wurde dies in einer großen randomisierten Studie bestätigt und zudem gezeigt, dass gewisse Patienten dadurch auch länger leben. Die adäquate Patientenselektion ist wohl die essenziellste Voraussetzung für eine erfolgreiche LVRS und gehört in die Hände eines erfahrenen Zentrums mit multidisziplinärer Emphysemkonferenz. Während das apikal betonte, heterogene Emphysem als beste Indikation gilt, gibt es ein ganzes Spektrum an Emphysemmorphologien, welche sich bei richtiger Auswahl ebenfalls für die Chirurgie eignen. Daneben existieren heutzutage mit den verschiedenen bronchoskopischen Verfahren an Evidenz und Qualität wachsende Methoden, welche die multidisziplinäre Behandlungspalette erweitern.

Abstract

In a number of large case series in the mid-1990s, lung volume reduction surgery (LVRS) was shown to reduce dyspnoea and improve pulmonary function and quality of life in patients with advanced pulmonary emphysema. The large randomised National Emphysema Treatment Trial (NETT) confirmed this in the early 2000s and also demonstrated that selected patients live longer after surgery. Patient selection is crucial to the success of the procedure and should be performed at a specialised experienced centre with a multidisciplinary team approach on emphysema treatment. The upper-lobe predominant heterogeneous type of emphysema is the best indication, but there are other types of emphysema morphology that are also eligible for surgery, if ideally chosen. Nowadays there is also growing evidence for positive effects after different types of bronchoscopic lung volume reduction (BLVR) with increasing quality. These methods add to the range of multimodal emphysema treatment.

Schlüsselwörter

Lungenvolumenreduktion - LVRS - Emphysem - COPD

Key words

lung volume reduction - LVRS - emphysema - COPD

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