Anastomosenprobleme bei der Manschettenresektion und Lungentransplantation

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.

Manschettenresektion - Lungentransplantation - bronchiale Anastomose - Intervention - Anastomosenprobleme

sleeve resection - lung transplantation - bronchial anastomosis - intervention - anastomotic problems

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