Der Pneumothorax - Behandlung und Ergebnisse

Zusammenfassung

Die videoassistierte thorakoskopische Chirurgie ist das Standardverfahren zur Versorgung des Pneumothorax geworden. Technische Fortschritte bei Kamera und Optik ermöglichen in Kombination mit endoskopischen Staplergeräten eine minimalinvasive Versorgung sowohl des primären als auch sekundären Pneumothorax. Die Differenzierung dieser zwei Formen gelingt zumeist präoperativ mittels HR-CT. Die Kombination aus Blasenresektion und partieller Pleurektomie bewirkt Rezidivraten unter 4 % und verkürzen nicht nur den Krankenhausaufenthalt, sondern minimieren auch die postoperativen Schmerzzustände. Solange keine professionelle Indikation (Musiker, Pilot, Taucher) vorliegt, behandeln wir das Erstereignis beim primären Spontanpneumothorax mit einer Thoraxdrainage und operieren erst beim Wiederauftreten.

Abstract

Thoracoscopy for the treatment of pneumothorax is the standard procedure in these days. Development of high resolution optics in combination with endoscopic stapler tools advanced to the minimal-invasive treatment of the primary and secondary pneumothorax. For differentiation of these two entities preoperative HR-CT scan is sufficient. The combination of bulla-resection and costal pleurectomy has recurrences in 4 %, trunk the hospital stay and minimise the postoperative pain. As long as the patient has no high risk activities (musicians, pilot, diver etc.), we treat the first pneumothorax with drains and perform surgery on recurrences.

Schlüsselwörter

Pneumothorax - VATS - Pleurodese - Postthorakotomieschmerz

Key words

Pneumothorax - VATS - Pleurodesis - Postthoracotomy pain

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