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Der Pneumologe

, Volume 17, Issue 1, pp 3–11 | Cite as

Bronchoskopische Therapie von malignen und benignen Atemwegsstenosen

  • Lutz FreitagEmail author
Leitthema

Zusammenfassung

Stenosen der zentralen Atemwege durch bösartige Tumore können zu quälender Luftnot führen. Chemo- und Strahlentherapie wirken verzögert. Mit endoskopischer Dilatation, Gewebeabtragung durch Laser, Argonplasma-Koagulation (APC) oder Kryosonde sowie durch Einlage von Stents kann die Lebensqualität sofort massiv verbessert werden. Gutartige Stenosen sind als Folge von lokalen Traumata wie Intubationen oder Entzündungen häufig. Sie werden oft erst spät bemerkt und beispielsweise als Asthma fehldiagnostiziert. Kurzstreckige narbige Stenosen können gut und langanhaltend endoskopisch mit Laser oder elektrischem Messer behandelt werden. Granulationsgewebe wird wie Tumorgewebe abgetragen, verbunden mit einer lokalen Gabe antiproliferativer Medikamente. Langstreckige, gutartige Strikturen kann man nur mit Stents erweitern. Man sollte aber unbedingt vorher die Möglichkeit der chirurgischen Resektion diskutieren, da langfristig mit Nebenwirkungen durch Stents zu rechnen ist. Individualisierte Stents könnten in naher Zukunft die therapeutischen Möglichkeiten verbessern.

Schlüsselwörter

Stent Bronchialkarzinom Dyspnoe Palliative Versorgung Laserchirurgie 

Bronchoscopic treatment of malignant and benign airway stenoses

Abstract

Stenoses of the central airways due to malignant tumors can cause torturous respiratory distress. Chemotherapy and radiation therapy have delayed effects. Endoscopic dilation, tissue removal with laser, argon plasma coagulation (APC), cryoresection or insertion of airway stents can massively improve the quality of life. Benign stenoses as the result of local trauma, such as intubation or inflammation are frequent. They are often first noticed later and for example misdiagnosed as asthma. Short scarred stenoses are easily endoscopically treated by a laser or electrosurgical knife with good long-term results. Excessive granulation tissue is removed like tumor tissue followed by local application of antiproliferative drugs. Lengthy benign strictures can only be dilated by stents; however, prior to stent implantation the option of a surgical resection must be discussed as in the long term the side effects from stents have to be considered. Individualized stents could improve the treatment options in the near future.

Keywords

Stent Lung cancer Dyspnea Palliative care Laser surgery 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

L. Freitag gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden vom Autor keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Hirslandenklinik St. AnnaLuzernSchweiz

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