Zusammenfassung
Der primäre Spontanpneumothorax (PSP) tritt überwiegend bei gesunden Männern unter 30 Jahren auf. Die Symptomatik reicht vom radiologischen Zufallsbefund ohne Beschwerden bis hin zur akuten Lebensgefahr. In der Regel wird die Diagnose klinisch gestellt und radiologisch bestätigt. Die Ausdehnung des Lungenkollaps und die Symptomatik entscheiden über das therapeutische Vorgehen. Bei einem Pneumothorax von weniger als 2 cm und asymptomatischen Patienten ist ein konservatives Vorgehen gerechtfertigt. Bei einem größeren und/oder symptomatischen Pneumothorax wird in der Akutsituation eine Thoraxdrainage gelegt. Bei nicht expandierender Lunge und Rezidiven ist ein chirurgisches Vorgehen indiziert. Häufig erfolgt eine Oberlappenspitzenresektion mit partieller parietaler Pleurektomie, die meist minimalinvasiv mittels videoassistierter Thorakoskopie (VATS) durchgeführt wird. Die Rezidivraten nach operativer Therapie liegen bei geringer Morbidität und Mortalität zwischen 1 und 7 %. Nach Spontanpneumothorax bzw. traumatischem Pneumothorax wird für Flugreisen eine Karenzzeit von 2–3 Wochen empfohlen.
This is a preview of subscription content, log in via an institution to check access.
Literatur
Adewole OO, De Keukeleire T, Phillips AS, et al. (2015) Effectiveness of thoracoscopic talc pleurodesis in the management of complicated spontaneous pneumothorax. J Bronchology Interv Pulmonol 22: 48–51. https://doi.org/10.1097/LBR.0000000000000134
Aerospace Medical Association (2003) Medical Guidelines for Airline Travel, 2nd ed. Aviat Space Environ Med 74: A1–19
Ahmedzai S, Balfour-Lynn IM, Bewick T, et al. (2011) Managing passengers with stable respiratory disease planning air travel: British Thoracic Society recommendations. Thorax 66 (Suppl 1): i1–30. https://doi.org/10.1136/thoraxjnl-2011–200295
Baumann MH, Strange C, Heffner JE, et al. (2001) Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement. Chest 119: 590–602
Bense L, Eklund G, Wiman LG (1987) Smoking and the increased risk of contracting spontaneous pneumothorax. Chest 92: 1009–1012
British Thoracic Societey Fitness to Dive Group (2003) British Thoracic Society guidelines on respiratory aspects of fitness for diving. Thorax 58: 3–13
Bunch A, Duchateau F-X, Verner L, et al. (2013) Commercial Air Travel After Pneumothorax: A Review of the Literature. Air Med J 32: 268–274. https://doi.org/10.1016/j.amj.2013.01.003
Casali C, Stefani A, Ligabue G, et al. (2013) Role of Blebs and Bullae Detected by High-Resolution Computed Tomography and Recurrent Spontaneous Pneumothorax. Ann Thorac Surg 95: 249–255. https://doi.org/10.1016/j.athoracsur.2012.05.073
Chen J-S, Hsu H-H, Kuo S-W, et al. (2009) Management of recurrent primary spontaneous pneumothorax after thoracoscopic surgery: should observation, drainage, redo thoracoscopy, or thoracotomy be used? Surg Endosc 23: 2438–2444. https://doi.org/10.1007/s00464–009–0404–8
Cheng Y-L, Huang T-W, Lin C-K, et al. (2009) The impact of smoking in primary spontaneous pneumothorax. J Thorac Cardiovasc Surg 138: 192–195. https://doi.org/10.1016/j.jtcvs.2008.12.019
Chiu C-Y, Chen T-P, Wang C-J, et al. (2014) Factors associated with proceeding to surgical intervention and recurrence of primary spontaneous pneumothorax in adolescent patients. Eur J Pediatr 173: 1483–1490. https://doi.org/10.1007/s00431–014–2352–0
CTS-Net Result Summary for Survey: Management of Initial Spontaneous Pneumothorax, CTSNet. www.ctsnet.org/article/result-summary-survey-management-initial-spontaneous-pneumothorax. (Zugriff 31.10.2016)
Czerny M, Salat A, Fleck T, et al. (2004) Lung wedge resection improves outcome in stage I primary spontaneous pneumothorax. Ann Thorac Surg 77: 1802–1805. https://doi.org/10.1016/j.athoracsur.2003.10.057
Fiorelli A, Accardo M, Vicidomini G, et al. (2014) Does cannabis smoking predispose to lung bulla formation? Asian Cardiovasc Thorac Ann 22: 65–71. https://doi.org/10.1177/0218492313478954
Ghezel-Ahmadi D, Bölükbas S, Fischer T, et al. (2012) Pneumothorax: welche Therapie ist notwendig? Zentralbl Chir 137: 214–222. https://doi.org/10.1055/s-0031–1284013
Gill A (2005) Bong lung: regular smokers of cannabis show relatively distinctive histologic changes that predispose to pneumothorax. Am J Surg Pathol 29: 980–982
Gesellschaft für Tauch- und Überdruckmedizin (GTÜM) (1998) Die Richtlinien der medizinischen Vorsorgeuntersuchung für Sporttaucher. http://www.swiss-cave-diving.ch/PDF-dateien/Tauglichkeit-GTUEM.pdf. (Zugriff 26.09.2016)
Gupta D, Hansell A, Nichols T, et al. (2000) Epidemiology of pneumothorax in England. Thorax 55: 666–671
Haga T, Kurihara M, Kataoka H (2014) The risk for re-expansion pulmonary edema following spontaneous pneumothorax. Surg Today 44: 1823–1827. https://doi.org/10.1007/s00595–013–0726-y
Haynes D, Baumann MH (2010) Management of pneumothorax. Semin Respir Crit Care Med 31: 769–780. https://doi.org/10.1055/s-0030–1269837
Imperatori A, Rotolo N, Gatti M, et al. (2008) Peri-operative complications of video-assisted thoracoscopic surgery (VATS). Int J Surg 6 (Suppl 1): S78–81. https://doi.org/10.1016/j.ijsu.2008.12.014
Imperatori A, Rotolo N, Spagnoletti M, et al. (2015) Risk factors for postoperative recurrence of spontaneous pneumothorax treated by video-assisted thoracoscopic surgery. Interact Cardiovasc Thorac Surg 20: 647–651. https://doi.org/10.1093/icvts/ivv022
International Air Transport Association (IATA) (2013) Medical Manual, 6th ed. www.iata.org/whatwedo/safety/health/Documents/medical-manual-2013.pdf. (Zugriff 19.03.2015)
Lippert HL, Lund O, Blegvad S, Larsen HV (1991) Independent risk factors for cumulative recurrence rate after first spontaneous pneumothorax. Eur Respir J 4: 324–331
MacDuff A, Arnold A, Harvey J (2010) Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax 65 (Suppl 2): ii18–31. https://doi.org/10.1136/thx.2010.136986
Mahfood S, Hix WR, Aaron BL, et al. (1988) Reexpansion pulmonary edema. Ann Thorac Surg 45: 340–345
Malik M, Black EA (2009) Fast-track video-assisted bullectomy and pleurectomy for pneumothorax: initial experience and description of technique. Eur J Cardiothorac Surg 36: 906–909; discussion 909. https://doi.org/10.1016/j.ejcts.2009.05.023
Margolis M, Gharagozloo F, Tempesta B, et al. (2003) Video-assisted thoracic surgical treatment of initial spontaneous pneumothorax in young patients. Ann Thorac Surg 76: 1661–1663; discussion 1663–1664
O’Rourke JP, Yee ES (1989) Civilian spontaneous pneumothorax. Treatment options and long-term results. Chest 96: 1302–1306
Pagès P-B, Delpy J-P, Falcoz P-E, et al. (2015) Videothoracoscopy versus thoracotomy for the treatment of spontaneous pneumothorax: a propensity score analysis. Ann Thorac Surg 99: 258–263. https://doi.org/10.1016/j.athoracsur.2014.08.035
Passlick B, Born C, Häussinger K, Thetter O (1998) Efficiency of video-assisted thoracic surgery for primary and secondary spontaneous pneumothorax. Ann Thorac Surg 65: 324–327
Sahn SA, Heffner JE (2000) Spontaneous pneumothorax. N Engl J Med 342: 868–874. https://doi.org/10.1056/NEJM200003233421207
Saiphoklang N, Kanitsap A (2013) Prevalence, clinical manifestations and mortality rate in patients with spontaneous pneumothorax in Thammasat University Hospital. J Med Assoc Thai 96: 1290–1297
Schramel FM, Postmus PE, Vanderschueren RG (1997) Current aspects of spontaneous pneumothorax. Eur Respir J 10: 1372–1379
Treasure T (2007) Minimally invasive surgery for pneumothorax: the evidence, changing practice and current opinion. J R Soc Med 100: 419–422. https://doi.org/10.1258/jrsm.100.9.419
Tschopp J-M, Rami-Porta R, Noppen M, Astoul P (2006) Management of spontaneous pneumothorax: state of the art. Eur Respir J 28: 637–650. https://doi.org/10.1183/09031936.06.00014206
Uramoto H, Shimokawa H, Tanaka F (2012) What factors predict recurrence of a spontaneous pneumothorax? J Cardiothorac Surg 7: 112. https://doi.org/10.1186/1749–8090–7-112
Vanderschueren RG (1990) The role of thoracoscopy in the evaluation and management of pneumothorax. Lung 168 Suppl: 1122–1125
Wopp-studie.com (ed) Die WOPP-Studie. www.wopp-studie.de (Zugriff 29.10.2016)
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 © Springer-Verlag GmbH Deutschland
About this chapter
Cite this chapter
Utzig, M., Neudecker, J. (2018). Management des Spontanpneumothorax. In: Schneider, P., Kruschewski, M., Buhr, H. (eds) Thoraxchirurgie für den Allgemein- und Viszeralchirurgen. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-48710-5_12
Download citation
DOI: https://doi.org/10.1007/978-3-662-48710-5_12
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-662-48709-9
Online ISBN: 978-3-662-48710-5
eBook Packages: Medicine (German Language)