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Bronchusmanschettenresektion

Perioperatives Risiko und funktionelles Ergebnis

Sleeve lobectomy

Perioperative risks and functional results

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Zusammenfassung

Die Lobektomie mit Bronchusmanschettenresektion ist ein etabliertes operatives Verfahren bei zentralen Lungenkarzinomen. Häufig ist die chirurgische Alternative zu diesem Eingriff die Pneumonektomie. Beschrieben wird das perioperative Risiko und das funktionelle Ergebnis nach Lobektomie mit Bronchusmanschettenresektion im Vergleich zur typischen Lobektomie und Pneumonektomie.

In Bezug auf die postoperative Morbidität unterscheiden sich die Eingriffe nur wenig. Allerdings ist die Letalität der Patienten nach Pneumonektomie deutlich höher. Bronchopleurale Fisteln treten bei Lobektomie und Manschettenlobektomie in vergleichbar hohen Raten auf, nach Pneumonektomie ist die Rate wesentlich höher. Gefürchtet bleibt die bronchovaskuläre Fistel nach Manschettenresektion. Funktionell entsprechen die postoperativen Werte der Manschettenlobektomie denen der Lobektomiepatienten und sind deutlich besser als nach Pneumonektomie.

Wenn möglich, ist die Manschettenresektion mit Lobektomie der Pneumonektomie vorzuziehen.

Abstract

Sleeve lobectomy is an established surgical procedure in patients with lung cancer. Usually the only surgical alternative would be a pneumonectomy. This article describes the perioperative risks and functional results in patients after sleeve lobectomy compared to pneumonectomy and typical lobectomy.

There were only minor differences with respect to postoperative morbidity comparing the different procedures but the mortality rate was higher following pneumonectomy. Bronchopleural fistula rates were also similar comparing lobectomy and sleeve lobectomy but elevated following pneumonectomy. Bronchovascular fistulas after sleeve lobectomy are potentially life-threatening. Postoperative pulmonary function tests showed similar values for lobectomy and sleeve lobectomy patients and were considerably better than following pneumonectomy.

Whenever possible sleeve lobectomy should take preference over pneumonectomy.

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  1. Abteilung Thorax- und Gefäßchirurgie, Klinik Löwenstein gGmbH, Im Geißhölzle 62, 74245, Löwenstein, Deutschland

    T.P. Graeter

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Correspondence to T.P. Graeter.

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Graeter, T. Bronchusmanschettenresektion. Chirurg 84, 469–473 (2013). https://doi.org/10.1007/s00104-012-2429-0

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  • DOI: https://doi.org/10.1007/s00104-012-2429-0

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