Möller T, Becker T, Egberts J-H
Klinik für Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland.
Chirurg. 2019 Jul;90(7):529-536. doi: 10.1007/s00104-019-0943-z.
Estimation of the perioperative risk plays a decisive role in the surgical indications, particularly in view of the demographic change. For this reason, prehabilitation concepts for reducing perioperative risk nowadays play an increasingly important role.
Presentation of the current recommendations for preoperative diagnostics in thoracic surgical interventions as well as existing prehabilitation concepts and their practical applicability.
A selective review of the literature was carried out by searching the electronic databases PubMed, Cochrane Library and ISRCTN, including the guidelines of the American College of Chest Physicians (ACCP) and the European Society of Thoracic Surgery (ESTS).
Preconditioning includes the conservative treatment of underlying diseases, smoking cessation and prehabilitation. Prehabilitation is an increasingly pressing concept in routine clinical practice, even though the evidence is limited due to the very heterogeneous study situation. Overall, however, there is a tendency for positive effects on the quality of life and postoperative complications as well as convalescence.
In addition to preoperative diagnostics to assess the perioperative risk, effective preconditioning of patients is also necessary. For this an interdisciplinary approach including anesthesia, pneumology, psychotherapy and physiotherapy is necessary. In addition to the conservative medicinal optimization, prehabilitation concepts are gaining in importance and will certainly become established in routine clinical practice. From the surgical perspective, minimally invasive approaches and parenchyma-sparing resections also serve to reduce risks.
围手术期风险评估在手术指征中起着决定性作用，尤其是考虑到人口结构变化。因此，如今用于降低围手术期风险的术前康复概念发挥着越来越重要的作用。
介绍胸外科手术干预中术前诊断的当前建议以及现有的术前康复概念及其实际适用性。
通过检索电子数据库PubMed、Cochrane图书馆和ISRCTN进行文献的选择性回顾，包括美国胸科医师学会（ACCP）和欧洲胸外科协会（ESTS）的指南。
预处理包括基础疾病的保守治疗、戒烟和术前康复。术前康复在常规临床实践中是一个日益紧迫的概念，尽管由于研究情况非常异质，证据有限。然而总体而言，对生活质量、术后并发症以及康复有积极影响的趋势。
除了评估围手术期风险的术前诊断外，对患者进行有效的预处理也是必要的。为此，需要一种包括麻醉、肺病学、心理治疗和物理治疗的跨学科方法。除了保守的药物优化外，术前康复概念正变得越来越重要，并且肯定会在常规临床实践中确立。从外科角度来看，微创方法和实质保留切除术也有助于降低风险。
