Skip to main content
SpringerLink
Log in

Tracheaverletzungen, Insuffizienz von Bronchusstumpf/-anastomose und Rekurrensparese

Management der Komplikationen in der Thoraxchirurgie

Tracheal injuries, fistulae from bronchial stump and bronchial anastomoses and recurrent laryngeal nerve paralysis

Management of complications in thoracic surgery

  • Leitthema
  • Published:
Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Komplikationen sind nicht immer vermeidbar und ihre Behandlung ist integraler Bestandteil einer hochwertigen medizinischen Versorgung. Komplikationen an großen Atemwegen sind selten, erfordern aber unbedingt die Mitbehandlung durch einen versierten Thoraxchirurgen.

Ziel der Arbeit

Der Leser soll Maßnahmen zur Komplikationsvermeidung, Früherkennung und zur Komplikationsbehandlung kennenlernen, um die Notwendigkeit für eine frühe interdisziplinäre Zusammenarbeit zu verstehen.

Material und Methoden

Eine selektive Literaturrecherche wurde durch eigene Erfahrungen ergänzt und mit prospektiv gewonnenem Bildmaterial ausgestattet.

Ergebnisse

Für das Auftreten aller genannten Komplikationen gibt es Risikokonstellationen, die der Chirurg erkennen sollte, um gezielt Maßnahmen der Früherkennung von Komplikationen zu ergreifen. Trachealverletzungen und Bronchusstumpfinsuffizienzen sind selten (< 5 %), dagegen kann eine Rekurrensparese nach linksseitiger Pneumonektomie in bis zu 30 % der Fälle auftreten.

Diskussion

Spätestens nach Auftreten einer Komplikation ist es wichtig, thoraxchirurgisch umgehend und konsequent zu handeln und, wenn erforderlich, andere Fachdisziplinen einzuschalten, um weiteren Schaden vom Patienten abzuwenden.

Abstract

Background

Complications cannot always be avoided and their treatment is an integral component of a high quality medical treatment. Complications of the central airways are rare but necessitate supportive treatment by an experienced thoracic surgeon.

Objective

The reader should become acquainted with measures to prevent complications, to recognize and treat complications early and should understand the necessity for an interdisciplinary approach.

Material and methods

A selective literature research was supplemented by personal experiences and complemented with prospectively collected photographs.

Results

There are risk constellations for the appearance of all the mentioned complications which the surgeon needs to know in order to be able to take measures for early detection of complications. Iatrogenic tracheal injuries and bronchial stump fistulae are rare (< 5 %) whereas recurrent laryngeal nerve palsy after left-sided pneumonectomy occurs in up to 30 % of cases.

Discussion

After the occurrence of complications at the latest, it is very important to include experienced thoracic surgeons and other specialists when necessary to protect the patient from further damage.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Hanna JM, Berry MF, D’Amico TA (2013) Contraindications of video-assisted thoracoscopic surgical lobectomy and determinants of conversion to open. J Thorac Dis 5(Suppl 3):S182–S189

    PubMed Central  PubMed  Google Scholar 

  2. Flores RM, Ihekweazu U, Dycoco J et al (2011) Video-assisted thoracoscopic surgery (VATS) lobectomy: catastrophic intraoperative complications. J Thorac Cardiovasc Surg 142:1412–1417

    Article  PubMed  Google Scholar 

  3. Welter S, Hoffmann H (2013) Injuries to the tracheo-bronchial tree. Zentralbl Chir 138(1):111–116

    Article  CAS  PubMed  Google Scholar 

  4. Schneider T, Volz K, Dienemann H, Hoffmann H (2009) Incidence and treatment modalities of tracheobronchial injuries in Germany. Interact Cardiovasc Thorac Surg 8:571–576

    Article  PubMed  Google Scholar 

  5. Grillo HC (2004) Reconstruction of the lower trachea (transthoracic) and procedures for extended resection. In: Grillo HC (Hrsg) Surgery of the Trachea and Bronchi. BC Decker Inc., Hamilton, S 587–598

  6. Cardillo G, Carbone L, Carleo F et al (2010) Tracheal lacerations after endotracheal intubation: a proposed morphological classification to guide non-surgical treatment. Eur J Cardiothorac Surg 37:581–587

    Article  PubMed  Google Scholar 

  7. Carbognani P, Bobbio A, Cattelani L et al (2004) Management of postintubation membranous trachealrupture. Ann Thorac Surg 77:406–409

    Article  PubMed  Google Scholar 

  8. Minambres E, Buron J, Ballesteros MA et al (2009) Tracheal rupture after endotracheal intubation: a literature systematic review. Eur J Cardiothorac Surg 95:1056–1062

    Article  Google Scholar 

  9. Hulscher JB, ter Hofstede E, Kloek J et al (2000) Injury to the major airways during subtotal esophagectomy: incidence, management, and sequelae. J Thorac Cardiovasc Surg 120(6):1093–1096

    Article  CAS  PubMed  Google Scholar 

  10. Zaheer S, Allen MS, Cassivi SD et al (2006) Postpneumonecctomy Empyema: results after the Clagett procedure. Ann Thorac Surg 82:279–287

    Article  PubMed  Google Scholar 

  11. Simon D, Lassau M, Schmidt-Wilcke P, Boucher M (2012) Intraoperative complications of neck surgery. Chirurg 83(7):626–632

    Article  CAS  PubMed  Google Scholar 

  12. Farkas EA, Detterbeck FC (2006) Airway complications after pulmonary resection. Thorac Surg Clin 16:243–251

    Article  PubMed  Google Scholar 

  13. Sfyridis PG, Kapetanakis EI, Baltayiannis NE et al (2007) Bronchial stump buttressing with an intercostal muscle flap in diabetic patients. Ann Thorac Surg 84:967–972

    Article  PubMed  Google Scholar 

  14. Alloubi I, Jougon J, Delcambre F et al (2010) Early complications after pneumonectomy: retrospective study of 168 patients. Interact Cardiovasc Thorac Surg 11(2):162–165

    Article  PubMed  Google Scholar 

  15. Lemaitre J, Mansour Z, Kochetkova EA et al (2006) Bronchoplastic lobectomy: do early results depend on the underlying pathology? A comparison between typical carcinoids and primary lung cancer. Eur J Cardiothorac Surg 30(1):168–171

    Article  PubMed  Google Scholar 

  16. Taghavi S, Marta GM, Lang G et al (2005) Bronchial stump coverage with a pedicled pericardial flap: an effective method for prevention of postpneumonectomy bronchopleural fistula. Ann Thorac Surg 79:284–288

    Article  PubMed  Google Scholar 

  17. Llewellyn-Bennett R, Wotton R, West D (2013) Prophylactic flap coverage and the incidence of bronchopleural fistulae after pneumonectomy. Interact Cardiovasc Thorac Surg 16:681–685

    Article  PubMed Central  PubMed  Google Scholar 

  18. Schneiter D, Cassina P, Korom S et al (2001) Accelerated treatment for early and late postpneumonectomy empyema. Ann Thorac Surg 72:1668–1672

    Article  CAS  PubMed  Google Scholar 

  19. Suzuki M, Otsuji M, Baba M et al (2002) Bronchopleural fistula after lung cancer surgery: multivariate analysis of risk factors. J Cardiovasc Surg 43:263–267

    CAS  Google Scholar 

  20. Algar FJ, Alvarez A, Aranda JL et al (2001) Prediction of early broncho-pleural fistula after pneumonectomy: a multivariant analysis. Ann Thorac Surg 72:1662–1667

    Article  CAS  PubMed  Google Scholar 

  21. al-Kattan K, Cattelani L, Goldstraw P (1995) Bronchopleural fistula after pneumonectomy for lung cancer. Eur J Cardiothorac Surg 9(9):479–482

    Article  CAS  PubMed  Google Scholar 

  22. Bylicki O, Vandemoortele T, Orsini B et al (2014) Incidence and management of anastomotic complications after bronchial resection: a retrospective study. Ann Thorac Surg 98:1961–1967

    Article  PubMed  Google Scholar 

  23. Hysi I, Rousse N, Claret A et al (2011) Open window thoracostomy and thoracoplasty to manage 90 postpneumonectomy empyemas. Ann Thorac Surg 92:1833–1839

    Article  PubMed  Google Scholar 

  24. Seo H, Kim TJ, Jin KN, Lee KW (2010) Multi-detector row computed tomographic evaluation of bronchopleural fistula: correlation with clinical, bronchoscopic, and surgical findings. J Comput Assist Tomogr 34(1):13–18

    Article  PubMed  Google Scholar 

  25. Clagett OT, Geraci JE (1963) A procedure for the management of postpneumonectomy empyema. J Thorac Cardiovasc Surg 45:141–145

    CAS  PubMed  Google Scholar 

  26. Gómez JMN, Carbajo MC, Concha DV et al (2012) Conservative treatment of post-lobectomy bronchopleural fistula. Interact Cardiovasc Thorac Surg 15:152–154

    Article  Google Scholar 

  27. Palmen M, Breugel HN van, Geskes GG et al (2009) Open window thoracostomy treatment of empyema is accelerated by vacuum-assisted closure. Ann Thorac Surg 88(4):1131–1136

    Article  PubMed  Google Scholar 

  28. Sziklavari Z, Grosser C, Neu R et al (2011) Complex pleural empyema can be safely treated with vacuum-assisted closure. J Cardiothorac Surg 6:130

    Article  PubMed Central  PubMed  Google Scholar 

  29. Hoffmann E, Jankowski J, Lersmacher J, Kantartzis M (1990) Extrapleurale Zugangswege bei der Versorgung der Bronchusstumpfinsuffizienz nach Pneumonektomie. Langenbecks Arch Chir 375:46–50

    Article  CAS  PubMed  Google Scholar 

  30. Maaßen W (1983) The extrapleural treatment of main bronchial stump fistulae using a contralateral approach. Thorac Cardiovasc Surg 31:320–321

    Article  PubMed  Google Scholar 

  31. Zahid I, Routledge T, Billé A, Scarci M (2011) What is the best treatment of postpneumonectomy empyema? Interact Cardiovasc Thorac Surg 12:260–264

    Article  PubMed  Google Scholar 

  32. Périé S, Laccourreye O, Bou-Malhab F, Brasnu D (1998) Aspiration in unilateral recurrent laryngeal nerve paralysis after surgery. Am J Otol 19:18–23

    Article  Google Scholar 

  33. Filaire M, Mom T, Laurent S et al (2001) Vocal cord dysfunction after left lung resection for cancer. Eur J Cardiothorac Surg 20:705–711

    Article  CAS  PubMed  Google Scholar 

  34. Laccourreye O, Malinvaud D, Delas B et al (2010) Early unilateral laryngeal paralysis after pulmonary resection with mediastinal dissection for cancer. Ann Thorac Surg 90(4):1075–1078

    Article  PubMed  Google Scholar 

  35. Langmore SE, Schatz K, Olsen N (1988) Fiberoptic endoscopic examination of swallowing safety: a new procedure. Dysphagia 2:209–215

    Article  Google Scholar 

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt. S. Welter, D. Cheufou, K. Darwiche und G. Stamatis geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. Abteilung Thoraxchirurgie und thorakale Endoskopie, Ruhrlandklinik, Westdeutsches Lungenzentrum am Universitätsklinikum Essen, Tüschener Weg 40, 45239, Essen, Deutschland

    S. Welter, D. Cheufou & G. Stamatis

  2. Abteilung Interventionelle Bronchologie, Ruhrlandklinik, Westdeutsches Lungenzentrum am Universitätsklinikum Essen, Essen, Deutschland

    K. Darwiche

Authors
  1. S. Welter
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Cheufou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. Darwiche
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G. Stamatis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Welter.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Welter, S., Cheufou, D., Darwiche, K. et al. Tracheaverletzungen, Insuffizienz von Bronchusstumpf/-anastomose und Rekurrensparese. Chirurg 86, 410–418 (2015). https://doi.org/10.1007/s00104-014-2862-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-014-2862-3

Schlüsselwörter

Keywords

Search

Navigation