S3-Leitlinie: Diagnostik und Therapie von Spontanpneumothorax und postinterventionellem Pneumothorax^[*]

Zusammenfassung

In Deutschland werden jedes Jahr 10.000 Fälle von Spontanpneumothorax stationär behandelt. Die Deutsche Gesellschaft für Thoraxchirurgie (DGT) hat in Kooperation mit der Deutschen Gesellschaft für Pneumologie und Schlafmedizin (DGP), der deutschen Röntgengesellschaft (DRG) und der Deutschen Gesellschaft für Innere Medizin (DGIM) in Moderation mit der Arbeitsgemeinschaft der wissenschaftlichen medizinischen Fachgesellschaften (AWMF) eine S3 Leitlinie zum Spontanpneumothorax und postinterventionellen Pneumothorax entwickelt.

Methode Ausgehend von der Quellleitlinie der Britisch Thoracic Society (BTS) zum Spontanpneumothorax von 2010 wurde eine Literaturrecherche zum Spontanpneumothorax ab 2008, zum postinterventionellen Pneumothorax ab 1960 durchgeführt. Den relevanten gefundenen Studien wurden Evidenzlevel nach dem Oxford Centre for Evidence-Based Medicine (2011) zugeteilt. Die Empfehlungen wurden in 3 Konsensuskonferenzen nach GRADE (A: „wir empfehlen“/„wir empfehlen nicht“, B: „wir schlagen vor“/„wir schlagen nicht vor“) im nominalen Gruppenprozess konsentiert.

Ergebnisse Die Algorithmen zum primären und sekundären Pneumothorax unterscheiden sich in der Indikation zur CT-Thorax sowie in der Indikationsstellung zur Drainagenanlage und minimalinvasiven Operation. Die Operation wird individuell empfohlen unter Berücksichtigung von Rezidivrisiko, Lebensumständen, Patientenpräferenzen und Prozedurenrisiko. Bei einigen Formen des sekundären Pneumothorax wird eine zurückhaltende Indikationsstellung zur Operation empfohlen. Die Therapie des postinterventionellem Spontanpneumothorax ähnelt dem des primären Spontanpneumothorax.

Diskussion Die Empfehlungen der S3-Leitlinie bieten Hilfestellungen im Management des Spontanpneumothorax und des postinterventionellen Pneumothorax. Ob diese auf derzeitig teilweise bestehende abweichende diagnostische und therapeutische Maßnahmen Einfluss haben, werden künftige epidemiologische Studien zeigen.

Schlüsselwörter

Spontanpneumothorax - Pneumothorax - primärer Spontanpneumothorax - sekundärer Spontanpneumothorax - postinterventioneller Pneumothorax - Thoraxdrainage - VATS

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