Zusammenfassung
Das parapneumonische Pleuraempyem wurde von internationalen Fachgesellschaften und namhaften Autoren unter verschiedensten Aspekten in differente, allgemein akzeptierte Stadien eingeteilt (American Thoracic Society [ATS] - Einteilung nach der natürlichen Verlaufsform; Light-Klassifikation - Einteilung nach der Zusammensetzung des Ergusses / Empyem; American College of Chest Physicians [ACCP] - Einteilung nach Risikokategorie für ein schlechtes Ergebnis). Die Behandlung des Pleuraempyems soll in allen Einteilungen adaptiert an das jeweilige Stadium erfolgen. Aus der Gesamtbetrachtung aller Einteilungen resultiert folgende Behandlungsempfehlung: Im Stadium I [ATS] / Light I-III / Risikokategorie I-II [ACCP] sollte in der Regel eine Punktion / Drainagetherapie ggf. plus zusätzlicher Antibiotikatherapie erfolgen, im Stadium II [ATS] / Light IV-VI / Risikokategorie III [ACCP] ist die videoassistierte Thorakoskopie (VATS) das Verfahren der Wahl, weil sie der katheter- oder drainagenassoziierten Fibrinolytika-Therapie deutlich überlegen ist, im Stadium III [ATS] / Light VII / Risikokategorie IV [ACCP] ist die Dekortikation - offen-chirurgisch oder per VATS - das Verfahren der Wahl.
Abstract
Parapneumonic pleural empyema has been classified by international societies and by pleural diseases experts into different stages and classes. While the American Thoracic Society (ATS) classification is based on the natural course of the disease, Light has classified pleural empyema according to radiological, physical and biochemical characteristics, and the American College of Chest Physicians (ACCP) has categorised patients with pleural empyema according to the risk of a poor outcome. According to these classifications, the management of the pleural empyema is based on the stage of the disease. The recommended treatment options in (ATS) stage I disease (Light classes I-III, ACCP categories I and II) are therapeutic thoracentesis or tube thoracostomy and antibiotics when necessary. In (ATS) stage II disease (Light classes IV-VI, ACCP category III), thoracoscopy (VATS) is the treatment of choice because it has a higher efficacy than treatment strategies that utilise tube thoracostomy or catheter-directed fibrinolytic therapy alone, whereas in (ATS) stage III disease (Light class VII, ACCP category IV), decortication via thoracoscopy or thoracotomy is the treatment of choice.
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Dr. med. Dipl. Oec. E. Hecker
Klinik für Thoraxchirurgie · Thoraxzentrum Ruhrgebiet · Ev. Krankenhaus Herne - Betriebsstelle Eickel
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