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Zentralbl Chir 2015; 140(S 01): S36-S42
DOI: 10.1055/s-0035-1546249
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Pulmonale Tuberkulose – ist die Chirurgie noch notwendig?

Pulmonary Tuberculosis – Is Surgery still Necessary?
L. V. Klotz
Thoraxchirurgisches Zentrum München, Lungenfachklinik Gauting & Ludwig-Maximilians-Universität München, Deutschland
,
M. Lindner
Thoraxchirurgisches Zentrum München, Lungenfachklinik Gauting & Ludwig-Maximilians-Universität München, Deutschland
,
R. A. Hatz
Thoraxchirurgisches Zentrum München, Lungenfachklinik Gauting & Ludwig-Maximilians-Universität München, Deutschland
› Author Affiliations
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Publication History

Publication Date:
09 September 2015 (online)

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Zusammenfassung

Hintergrund: Tuberkulose zählt weltweit neben HIV und Malaria immer noch zu den häufigsten Infektionserkrankungen und stellt eine ernste Problematik im Gesundheitsbereich dar. Durch Einwanderer und Flüchtlinge ist die Erkrankung auch in Europa weiterhin präsent. Die globale Zunahme einer multiresistenten Tuberkulose führt somit zu einer hoch bedeutsamen und aktuellen Wichtigkeit suffizienter Therapiemaßnahmen. Dies hat in den letzten Jahren zu einer erneuten Evaluation der chirurgischen Therapie im Rahmen der interdisziplinären und multimodalen Therapie der multiresistenten Tuberkulose geführt. Zudem bestehen trotz effektiver medikamentöser Therapie der antibiotikaempfindlichen Tuberkulose weiterhin Indikationen zur chirurgischen Therapie. Neben der massiven Hämoptoe als notfallmäßige Operationsindikation stehen hier vor allem tuberkulöse Sekundärkomplikationen wie Aspergillome, chronische Hämoptysen, Pneumothorax, bronchopleurale Fisteln und zerstörte Areale des Lungenparenchyms („destroyed lung“) im Vordergrund. Schlussfolgerung: Die interdisziplinäre OP-Indikation sollte stets in einem multimodalen Therapiekonzept unter Berücksichtigung von Patientenalter und Funktionsanalysen gestellt werden. Eine antituberkulostatische Therapie sollte vor und nach einer Operation suffizient durchgeführt werden, um einen nachhaltigen Therapieerfolg verzeichnen zu können.

Abstract

Background: Tuberculosis is still one of the most common infectious diseases along with HIV and malaria and therefore represents a serious problem in the health sector. Due to immigrants and refugees, the disease is also present in Europe. The global increase of multidrug resistant tuberculosis leads to a highly significant and current importance of sufficient therapeutic measures. In recent years, this fact has led to a reevaluation of surgical therapy in the context of an interdisciplinary and multimodal treatment of multidrug resistant tuberculosis. In addition, despite an effective treatment of drug sensitive tuberculosis with antibiotics, there are still indications for surgery in the treatment of tuberculosis. Beside massive hemoptysis as an emergency indication for surgical intervention, secondary complications of tuberculosis such as aspergilloma, chronic hemoptysis, pneumothorax, bronchopleural fistula and destroyed lung remain indications for surgery. Conclusion: The indication for surgery should always be made in a multimodal therapeutic approach by an interdisciplinary team, taking patient age and functional analysis into account. Effective antibiotic therapy should be performed before and after surgery in order to achieve a sustained treatment success.

Schlüsselwörter

Thoraxchirurgie - Lungentuberkulose - Aspergillom - Behandlung - Tuberkulose

Key words

thoracic surgery - pulmonary tuberculosis - aspergilloma - treatment - tuberculosis
 

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