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Kinder- und Jugendmedizin 2021; 21(03): 168-178
DOI: 10.1055/a-1485-6601
Schwerpunkt

Aktuelle Behandlung der Trichterbrust und Kielbrust

Current treatment of pectus excavatum and carinatum
Peter Zimmermann∗
1   Klinik und Poliklinik für Kinderchirurgie, Universitätsklinikum Leipzig
,
Illya Martynov∗
1   Klinik und Poliklinik für Kinderchirurgie, Universitätsklinikum Leipzig
,
Sebastian Krämer∗
2   Klinik und Poliklinik für Thoraxchirurgie, Universitätsklinikum Leipzig
,
Daniel Gräfe∗
3   Institut für Kinderradiologie, Universitätsklinikum Leipzig
,
Franz Wolfgang Hirsch∗
3   Institut für Kinderradiologie, Universitätsklinikum Leipzig
,
Martin Lacher∗
1   Klinik und Poliklinik für Kinderchirurgie, Universitätsklinikum Leipzig
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ZUSAMMENFASSUNG

Die Trichterbrust ist die häufigste Form der Brustwanddeformitäten. Die Therapieentscheidung erfolgt stets gemeinsam zwischen Patient, den Eltern und dem Chirurgen in wiederholten Gesprächen. Die nicht-invasive Saugglockentherapie stellt für Kinder, welche die Kriterien für eine operative Korrektur nicht erfüllen oder eine chirurgische Therapie ablehnen, eine gute Alternative dar und birgt keine Gefahren. Seit Einführung der minimalinvasiven Trichterbrustkorrektur (MIRPE) hat die Anzahl von Patienten, die eine operative Korrektur Ihrer PE wünschen, deutlich zugenommen. Die Ergebnisse der operativen Korrektur zeigen neben einer hohen Patientenzufriedenheit mit dem kosmetischen Ergebnis auch eine verbesserte Herzleistung und Sauerstoffaufnahmekapazität. Obwohl die MIRPE in erfahrenen Händen sicher und effektiv ist, sind ernsthafte lebensbedrohliche Komplikationen möglich.

Zur Behandlung der Kielbrust ist die nicht-invasive Kompressionstherapie Therapie der Wahl. Dies gilt besonders für die dynamische Kompressionstherapie, welche eine objektive Messung und Einstellung der notwendigen Therapiedrücke, ein laterales Ausweichen der Thoraxwand und individuelle Anpassung ermöglicht. Der Therapieerfolg der Kompressionstherapie liegt „in der Hand des Patienten“. Eine operative Korrektur sollte nur nach nicht erfolgreicher Kompressionstherapie oder bei unbedingtem Patientenwunsch erfolgen.

ABSTRACT

Pectus excavatum (PE) is the most common chest wall deformity. The treatment is based on repeated counselling of the patient and the parents. In children who do not meet the criteria for a surgical approach or refrain from surgery the vacuum-bell is a good option. Since the introduction of minimally invasive repair of pectus excavatum (MIRPE), the number of patients requesting surgical correction has increased significantly. MIRPE leads to a high level of patient satisfaction, improves cardiac output and oxygen uptake capacity. In experienced hands MIRPE is safe and effective; however, serious life-threatening complications are possible.

For pectus carinatum (PC) non-invasive compression therapy (“bracing”) is the treatment of choice. The dynamic compression therapy shows objective measurement and adjustment of the therapeutic pressures, lateral evasion of the thorax wall and individual adjustment which results in excellent outcome. Surgical correction should only be carried out in case of unsuccessful compression therapy.

Schlüsselwörter

Brustwanddeformität - Saugglockentherapie - minimalinvasive Trichterbrustkorrektur - Kompressionstherapie

Keywords

Chest wall deformity - vacuum-bell therapy - minimally invasive repair of pectus excavatum - compression therapy


Publikationsverlauf

Eingereicht: 24. November 2020

Angenommen: 04. Dezember 2020

Artikel online veröffentlicht:
17. Juni 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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