{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,1,18]],"date-time":"2024-01-18T17:04:22Z","timestamp":1705597462288},"reference-count":61,"publisher":"Georg Thieme Verlag KG","issue":"06","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pneumologie"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title><jats:p>\n          Hintergrund\u2002Der Chylothorax ist i.\u200ad.\u200aR. eine multifaktorielle Komplikation nach Operationen oder Unf\u00e4llen, seltener die Folge von Tumoren. Da prospektive, randomisierte Studien fehlen, beruht die evidenzbasierte Behandlung auf pers\u00f6nlichen Erfahrungen, im Idealfall erfolgt sie in Kenntnis retrospektiver Analysen.<\/jats:p><jats:p>\n          Material und Methoden\u2002Ziel dieser \u00dcbersichtsarbeit ist es, einen umfassenden \u00dcberblick \u00fcber die aktuell zur Verf\u00fcgung stehenden modernen Behandlungsverfahren beim postoperativen Chylothorax zu geben sowie ihre Vor- und Nachteile aufzuzeigen. Hierzu erfolgte eine Literaturrecherche in der Datenbank \u201ePubMed\u201c unter Beschr\u00e4nkung auf Publikationen der letzten 10 Jahre. F\u00fcr die Recherche wurde das Schl\u00fcsselwort \u201eChylothorax\u201c eingesetzt. Der Schwerpunkt lag auf den Publikationen, die eine vergleichende Bewertung der Behandlungsm\u00f6glichkeiten beinhalten. Bei der kritischen Analyse der Therapieans\u00e4tze und Empfehlungen wurden Reviews der letzten 5 Jahre bevorzugt, des Weiteren st\u00fctzten sich die Autoren auf eine kumulative langj\u00e4hrige klinische Erfahrung.<\/jats:p><jats:p>\n          Ergebnisse\u2002Der Erfolg einer konservativen Behandlung zeigt in Abh\u00e4ngigkeit von der \u00c4tiologie eine gro\u00dfe Streuungsbreite (3\u201390\u200a%). Die Erfolgsrate der nicht invasiven oder semiinvasiven Verfahren liegt zwischen 50 und 100\u200a%, ebenfalls in Abh\u00e4ngigkeit von der \u00c4tiologie. Bei einer erfolglosen konservativen Behandlung operabler Patienten besteht die chirurgische Standardtherapie in der meist thorakoskopisch durchgef\u00fchrten Ligatur des Ductus thoracicus. Alternativ kann eine Pleurodese oder die Platzierung einer permanenten Thoraxdrainage oder eines pleuroperitonealen Shunts durchgef\u00fchrt werden. Die Erfolgsrate dieser Eingriffe liegt zwischen 64 und 100\u200a%. Die Morbidit\u00e4ts- und Mortalit\u00e4tsrate kann hierbei Werte bis zu 25\u200a% erreichen.<\/jats:p><jats:p>\n          Schlussfolgerung\u2002Die Behandlung eines Chylothorax sollte konservativ begonnen werden. Anschlie\u00dfend kann stufenweise eine aggressivere Therapie empfohlen werden, wobei der Zustand des Patienten und das Drainagevolumen den Entscheidungsprozess steuern. Interventionelle radiologische Verfahren sind sicher in der Anwendung bei gleichzeitig hoher Erfolgsquote und haben somit einen berechtigten Platz neben der konservativen Behandlung bzw. den operativen Verfahren. Sie stehen allerdings aktuell nur in einigen gr\u00f6\u00dferen Zentren zur Verf\u00fcgung.<\/jats:p>","DOI":"10.1055\/a-1172-7288","type":"journal-article","created":{"date-parts":[[2021,6,11]],"date-time":"2021-06-11T22:37:57Z","timestamp":1623451077000},"page":"439-446","source":"Crossref","is-referenced-by-count":2,"title":["Systematische \u00dcbersichtsarbeit: moderne Behandlungsverfahren beim postoperativen Chylothorax"],"prefix":"10.1055","volume":"75","author":[{"given":"S.","family":"Stange","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Thoraxchirurgie, Regiomed Kliniken GmbH, Sonneberg\/Coburg"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Z.","family":"Sziklavari","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Thoraxchirurgie, Regiomed Kliniken GmbH, Sonneberg\/Coburg"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2021,6,11]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.rmed.2009.08.010","article-title":"Chylothorax: aetiology, diagnosis and therapeutic options","volume":"104","author":"E E McGrath","year":"2010","journal-title":"Respir Med"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"867","DOI":"10.4065\/80.7.867","article-title":"Etiology of chylothorax in 203 patients","volume":"80","author":"C H Doerr","year":"2005","journal-title":"Mayo Clin Proc"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"e58","DOI":"10.1177\/021849230701500525","article-title":"Chylothorax following cardiac surgery caused by unusual lymphatic anatomy","volume":"15","author":"P Narayan","year":"2007","journal-title":"Asian Cardiovasc Thorac Ann"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1186\/1749-8090-8-72","article-title":"Radiotherapy in the treatment of postoperative chylothorax","volume":"8","author":"Z Sziklavari","year":"2013","journal-title":"J Cardiothorac Surg"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"e346","DOI":"10.1016\/j.jviscsurg.2011.09.006","article-title":"Management of postoperative chylothorax","volume":"148","author":"M Chalret du Rieu","year":"2011","journal-title":"J Visc Surg"},{"key":"ref6","first-page":"819","article-title":"Therapieoptionen beim Chylothorax","volume":"110","author":"H H Schild","year":"2013","journal-title":"Dtsch Arztebl Int"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1055\/a-0608-5082","article-title":"Prevention and surgical therapy of chylothorax","volume":"143","author":"T Glatz","year":"2018","journal-title":"Zentralbl Chir"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1136\/thx.31.5.610","article-title":"Chylothorax: report of a case complicating ductus ligation through a median sternotomy, and review","volume":"31","author":"T K Kaul","year":"1976","journal-title":"Thorax"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1016\/j.injury.2015.12.015","article-title":"A review of traumatic chylothorax","volume":"47","author":"T G Pillay","year":"2016","journal-title":"Injury"},{"key":"ref10","first-page":"213","article-title":"Complications and management of complications in oesophageal surgery","volume":"136","author":"A H H\u00f6lscher","year":"2011","journal-title":"Zentralbl Chir"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1016\/j.athoracsur.2014.03.003","article-title":"The incidence and management of postoperative chylothorax after pulmonary resection and thoracic mediastinal lymph node dissection","volume":"98","author":"A S Bryant","year":"2014","journal-title":"Ann Thorac Surg"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1200\/JCO.2007.14.1911","article-title":"Phase II trial of preoperative chemoradiotherapy followed by surgical resection in patients with superior sulcus non-small-cell lung cancers: report of Japan Clinical Oncology Group trial 9806","volume":"26","author":"H Kunitoh","year":"2008","journal-title":"J Clin Oncol"},{"key":"ref13","volume-title":"Chylothorax. 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