Lungenklinik Köln-Merheim, Lehrstuhl Thoraxchirurgie der Universität Witten-Herdecke, Witten-Herdecke, Germany,
Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Ulm, Germany.
Respiration. 2019;97(4):370-402. doi: 10.1159/000490179. Epub 2018 Jul 24.
In Germany, 10,000 cases of spontaneous pneumothorax are treated inpatient every year. The German Society for Thoracic Surgery, in co-operation with the German Society for Pulmonology, the German Radiological Society, and the German Society of Internal Medicine has developed an S3 guideline on spontaneous pneumothorax and post-interventional pneumothorax moderated by the German Association of Scientific Medical Societies.
Based on the source guideline of the British Thoracic Society (2010) for spontaneous pneumothorax, a literature search on spontaneous pneumothorax was carried out from 2008 onwards, for post-interventional pneumothorax from 1960 onwards. Evidence levels according to the Oxford Center for Evidence-Based Medicine (2011) were assigned to the relevant studies found. Recommendations according to grade (A: "we recommend"/"we do not recommend," B: "we suggest"/"we do not suggest") were determined in 3 consensus conferences by the nominal group process.
The algorithms for primary and secondary pneumothorax differ in the indication for CT scan as well as in the indication for chest drainage application and video-assisted thoracic surgery. Indication for surgery is recommended individually taking into account the risk of recurrence, life circumstances, patient preferences, and procedure risks. For some forms of secondary pneumothorax, a reserved indication for surgery is recommended. Therapy of post-interventional spontaneous pneumothorax is similar to that of primary spontaneous pneumothorax.
The recommendations of the S3 Guideline provide assistance in managing spontaneous pneumothorax and post-interventional pneumothorax. Whether this will affect existing deviant diagnostic and therapeutic measures will be demonstrated by future epidemiological studies.
在德国，每年有 10000 例自发性气胸需要住院治疗。德国胸外科协会与德国肺病学会、德国放射学会和德国内科医学学会合作，制定了自发性气胸和介入后气胸的 S3 指南，该指南由德国科学医学协会进行了调整。
基于英国胸科学会（2010 年）自发性气胸的原始指南，对 2008 年以来自发性气胸和 1960 年以来介入后气胸的文献进行了检索。根据牛津循证医学中心（2011 年）的证据水平，对发现的相关研究进行了评估。在 3 次共识会议上，通过名义群体过程，根据等级（A：“我们建议”/“我们不建议”，B：“我们建议”/“我们不建议”）确定了推荐意见。
原发性和继发性气胸的算法在 CT 扫描指征、胸腔引流应用指征和电视辅助胸腔镜手术指征上存在差异。手术指征是根据复发风险、生活情况、患者偏好和手术风险，单独推荐的。对于某些类型的继发性气胸，建议保留手术指征。介入后自发性气胸的治疗与原发性自发性气胸相似。
S3 指南的推荐意见有助于管理自发性气胸和介入后气胸。这些建议是否会影响现有的不同诊断和治疗措施，将由未来的流行病学研究来证明。
