Zusammenfassung
Resektionen am Bronchialsystem mit anschließender Anastomosierung sind eher Stenose-
als Insuffizienz-gefährdet. Die Insuffizienz ist jedoch mit einer erheblich höheren
Letalität verknüpft und akut behandlungsbedürftig. Die Stenose kann oftmals interventionell
suffizient behandelt werden. Die wesentlichen Risikofaktoren für die Entwicklung von
bronchialen Anastomosenproblemen liegen in der Kombination aus kardialen und pulmonalen
Risikofaktoren. Eine neoadjuvante Therapie beim Malignom bzw. die Standard-Immunsuppression
beim Transplantierten stellen keinen wesentlichen Risikofaktor für die Letalität,
aber für die Morbidität dar. Bronchiale Revaskularisationen sind trotz guter Ergebnisse
in der Praxis kaum verbreitet. Plastiken um die Anastomosen aus Muskel- oder Fettgewebe
haben sich nicht bewährt. Teleskopanastomosen wurden zugunsten von End-zu-End-Anastomosen
verlassen. Chirurgische Therapieoptionen bei der Insuffizienz sind außer der Restpneumektomie
immer in Kombination mit interventionellen Methoden wie Stent oder Klebung zu sehen.
Bei der Stenose stehen die interventionellen Verfahren im Vordergrund.
Abstract
Resections and subsequent anastomoses of the bronchial system are at a higher risk
of stenosis than insufficiency. Though insufficiency is correlated with a higher mortality
and is to be treated immediately. Often stenosis can be managed sufficiently by bronchoscopic
intervention. A combination of cardial and pulmonary risk factors is crucial for the
development of bronchial anastomostic problems. Neoadjuvant chemoradiation for malignant
disease or standard immunosuppression after transplantation is correlated with a higher
rate of morbidity but not mortality. Bronchial revascularization is not widely used
despite good results. Wrapping techniques around the anastomosis with omentum or muscle
have not shown any advantage in bronchial wound healing. Anastomotic telescoping was
left for end-to-end anastomoses. In case of insufficiency surgical therapeutic options
are always to be seen in combination with interventional strategies like stenting
or fibrin glue. Stenoses are a domain of interventional procedures.
Schlüsselwörter
Manschettenresektion - Lungentransplantation - bronchiale Anastomose - Intervention
- Anastomosenprobleme
Key words
sleeve resection - lung transplantation - bronchial anastomosis - intervention - anastomotic
problems
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Dr. med. T. Strauss
Chirurgische Klinik und Poliklinik der LMU München Großhadern
Marchioninistr. 15
81377 München
Phone: 0 89/7 09 50
Email: tim.strauss@med.uni-muenchen.de
