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Zentralbl Chir 2015; 140(1): 113-128
DOI: 10.1055/s-0033-1358087
DOI: 10.1055/s-0033-1358087
Refresher
Therapie von Bronchiektasen
Therapy of BronchiectasisFurther Information
Publication History
Publication Date:
27 February 2015 (online)
Zusammenfassung
Die Prävalenz von Non-CF-Bronchiektasen (nicht mit zystischer Fibrose assoziierte Bronchiektasen) steigt mit zunehmendem Alter in der Bevölkerung an. Da die Ätiologie vielfältig ist, ist eine umfangreiche Diagnostik erforderlich. Diese umfasst eine gründliche Anamnese sowie die HRCT des Thorax. In der HRCT kann gleichzeitig Lokalisation und Ausmaß des Lungenbefalls bestimmt werden. Die therapeutischen Optionen orientieren sich an den zugrunde liegenden pathophysiologischen Mechanismen Infektion, Inflammation, Sekretretention und Destruktion und sollten abgestuft, aber konsequent zum Einsatz kommen. Bei häufigen Exazerbationen oder einer schweren Erkrankung sollte über den Einsatz von inhalativen Antibiotika und Makroliden nachgedacht werden. Die Operation von Bronchiektasen stellt inzwischen ein eher seltenes Ereignis dar und ist oftmals auf die Behandlung medikamentös nicht mehr zu beherrschender, lebensbedrohlicher Komplikationen der Bronchiektasenkrankheit wie Hämoptysen, Aspergillom, Lungenabszess und Pleuraempyem ausgerichtet. Die beiden Grundvoraussetzungen für eine erfolgreiche chirurgische Therapie mit gutem Langzeitergebnis stellen dar:
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