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Talkumpleurodese mittels internistischer Thorakoskopie beim malignen oder chronischen Pleuraerguss

Talc pleurodesis via medical thoracoscopy for malignant or chronic pleural effusion

  • Leitthema
  • Published:
Der Pneumologe Aims and scope

Zusammenfassung

Talkum gilt heute als Mittel der Wahl zur Durchführung einer Pleurodese, da es je nach Applikationsform eine Erfolgsrate von über 90% und nur wenige Nebenwirkungen aufweist. Talkum ist eine asbestfreie Substanz, die neben Talk auch Chlorit und einige Spurenmetalle enthält. Als Pulver wird es unter thorakoskopischer Sicht auf beide Pleurablätter aufgesprüht; als Suspension in physiologischer Kochsalzlösung (Slurry) kann es über die Pleuradrainage in den Pleuraraum instilliert werden. Talkum schädigt Mesothelzellen innerhalb von 24 Stunden. Die daraus resultierende Entzündung führt zu einer Verklebung der Pleurablätter. Die Anwendung wurde in einer Fülle von Studien untersucht, sie ist sicher und hat eine hohe Kosten-Nutzen-Relation. In dieser Übersicht werden Talkum, die verschiedenen Applikationsformen und wichtige klinische Aspekte, die sich aus der Anwendung ergeben, besprochen.

Abstract

Talc is considered today as the agent of choice for pleurodesis, since it has a success rate of over 90%, depending on the application method used. Talc is a natural, asbestos-free product composed of talc, chlorite, and trace minerals. The powder is sprayed thoracoscopically on both pleural layers under visual control, whereas the slurry is instilled through the chest tube. Talc damages the mesothelial cells within 24 h. The resulting inflammation induces symphysis between the pleural layers. The application of talc has been widely studied; it is safe with rare adverse effects, widely available, and cost-efficient. This review gives an overview and offers tips and tricks for the use of talc as poudrage and slurry.

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  1. Klinik für Lungen- und Bronchialmedizin, Klinikum Kassel, Mönchebergstr. 41, 34125, Kassel, Deutschland

    A. Gillissen

  2. Klinik für Thoraxchirurgie, Klinikum Kassel, Kassel, Deutschland

    S. Kellner

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  1. A. Gillissen
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  2. S. Kellner
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Correspondence to A. Gillissen.

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Gillissen, A., Kellner, S. Talkumpleurodese mittels internistischer Thorakoskopie beim malignen oder chronischen Pleuraerguss. Pneumologe 7, 336–342 (2010). https://doi.org/10.1007/s10405-009-0391-4

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