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[气胸]

[Pneumothorax].

作者信息

Eggeling Stephan

出版信息

Zentralbl Chir. 2021 Feb;146(1):126-144. doi: 10.1055/a-1256-6008. Epub 2021 Feb 15.

Abstract

A pneumothorax is defined by the presence of free air between the pleura visceralis and the pleura partietalis. The lung separates from the chest wall, which then, depending on several parameters, leads to a slight or clinically threatening impairment of lung function. Non-specific signs such as thoracic pain or coughing are common and do not correlate with the extent of the pneumothorax. Almost without exception, the cause of this accumulation of air is a leakage in the lung's surface, which then results in air escaping into the pleural space. Depending on the cause of the "lung leakage", a distinction is made between a primary (idiopathic) spontaneous pneumothorax (PSP) that can be triggered without direct cause, and a secondary spontaneous pneumothorax (SSP) in case of an underlying known lung disease. Further between an iatrogenic pneumothorax in connection with a lung injury caused by medical measures, and a traumatic pneumothorax in the case of an accident-related lung tear. The relevant therapeutic goals are the elimination of the acute symptoms, the reliable achievement of re-expansion of the lungs, and, after appropriate information gathering about the probability and clinical significance of a pneumothorax recurrence and depending on the patient's wish, avoiding a recurrence by means of surgical measures. The therapy options range from a "wait-and-see" procedure, that merely monitors the findings, to a primary video-assisted thoracoscopic surgical therapy with detection and resection of the superficial lung lesion, as well as a measurement to obliterate the pleural cavity that prevents relapse. Regarding "follow-up care" or even behavioral recommendations after a pneumothorax, there are no recommendations that reduce the risk of recurrence.

摘要

气胸的定义是脏层胸膜和壁层胸膜之间存在游离气体。肺与胸壁分离,这随后根据几个参数导致肺功能出现轻微或临床上有威胁的损害。胸痛或咳嗽等非特异性症状很常见,且与气胸的程度无关。几乎无一例外,这种气体积聚的原因是肺表面的渗漏,进而导致空气逸入胸膜腔。根据“肺渗漏”的原因,可分为原发性(特发性)自发性气胸(PSP),其可在无直接原因的情况下引发;以及继发性自发性气胸(SSP),即存在已知的潜在肺部疾病的情况。此外还有与医疗措施导致的肺损伤相关的医源性气胸,以及因事故相关的肺撕裂导致的创伤性气胸。相关的治疗目标是消除急性症状,可靠地实现肺复张,并且在适当收集关于气胸复发的可能性和临床意义的信息后,根据患者的意愿,通过手术措施避免复发。治疗选择范围从仅监测病情的“观察等待”程序,到通过检测和切除浅表肺病变进行的原发性电视辅助胸腔镜手术治疗,以及一种消除胸膜腔以防止复发的措施。关于气胸后的“后续护理”甚至行为建议,目前尚无降低复发风险的建议。

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