{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T00:17:42Z","timestamp":1764202662693,"version":"3.46.0"},"reference-count":31,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Zentralbl Chir"],"abstract":"<jats:title>Zusammenfassung<\/jats:title>\n                  <jats:p>Die operative Zwerchfellraffung bei einseitiger Zwerchfellparese wird in vielen Kliniken in geringer Fallzahl durchgef\u00fchrt. Zu diesem Thema gibt es bisher keine randomisierte Studie und keine Leitlinie. Ziel der vorliegenden Konsensusfindung war es, einheitliche Mindestanforderungen an die Diagnostik, operative Therapie und das postoperative Management bei einseitiger Zwerchfellparese zu erarbeiten und damit die Versorgungsqualit\u00e4t dieser seltenen Erkrankung zu verbessern.<\/jats:p>\n                  <jats:p>In einem strukturierten, modifizierten Delphi-Prozess wurden Experten der Deutschen Gesellschaft f\u00fcr Thoraxchirurgie (DGT) zum operativen Management der einseitigen symptomatischen Zwerchfellparese befragt und Empfehlungen mit einer Zustimmung von \u2265\u00a080% extrahiert. Es wurden gezielt alle Leitungen von thoraxchirurgischen Abteilungen einbezogen, deren Klinik als Lungenkrebszentrum oder als Kompetenzzentrum zertifiziert waren.<\/jats:p>\n                  <jats:p>Nach 2 Onlinefragerunden und einem Arbeitstreffen der Experten konnten 14 Empfehlungen zum operativen Management der einseitigen symptomatischen Zwerchfellparese abgestimmt werden: F\u00fcr die Diagnostik soll eine Computertomografie (KM-CT) von Hals und Thorax und bei Hinweisen auf eine obstruktive Schlafapnoe eine Schlaflabordiagnostik durchgef\u00fchrt werden. Die Indikationsstellung zur operativen Zwerchfellraffung basiert auf der Kombination von Zwerchfellhochstand, spezifischen Beschwerden und dem Vorliegen funktioneller Einschr\u00e4nkungen. Die Anwendung des Diaphragm Paralysis Questionnaire (DPQ) wird empfohlen. Bei Hinweisen auf einen zervikalen Bandscheibenvorfall soll zun\u00e4chst der Erfolg einer lokalen Behandlung abgewartet werden. Bei unklarer Zwerchfellparese ist von Symptombeginn bis zur Operation eine Wartezeit von mindestens 6 Monaten einzuhalten. Die Operation soll minimalinvasiv ohne Zwerchfellresektion durchgef\u00fchrt und Verwachsungen sollen angemessen gel\u00f6st werden.\n        Nahtlager-Patches sollen mit den Raffungsn\u00e4hten verwendet und ein Kunstnetz nach Einsch\u00e4tzung des Operateurs eingesetzt werden. Eine Drainage ist ausreichend. Postoperativ soll die Mobilisation und Belastung spezifisch angepasst werden, aber im Krankenhaus wie nach Lungenresektion fr\u00fchzeitig erfolgen. Es wird eine symptomorientierte Nachsorgeuntersuchung nach 6\u201312 Monaten empfohlen.<\/jats:p>\n                  <jats:p>Es konnten 14 Mindeststandards f\u00fcr das operative Management der einseitigen Zwerchfellparese konsentiert werden. Diese werden den Mitgliedern der DGT empfohlen.<\/jats:p>","DOI":"10.1055\/a-2738-2839","type":"journal-article","created":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T00:14:24Z","timestamp":1764202464000},"source":"Crossref","is-referenced-by-count":0,"title":["Thoraxchirurgisches Management der einseitigen symptomatischen Zwerchfellparese: Konsensusstatement einer Expertengruppe basierend auf dem modifizierten Delphi-Verfahren"],"prefix":"10.1055","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4194-8215","authenticated-orcid":false,"given":"Stefan","family":"Welter","sequence":"additional","affiliation":[{"name":"Thoraxchirurgie, Lungenklinik Hemer, Hemer, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Morris","family":"Beshay","sequence":"additional","affiliation":[{"name":"Thoraxchirurgie, Evangelisches Klinikum Bethel gGmbH, Bielefeld, 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