Liječenje pneumotoraksa

Abstract

Pluća oblaže tanka ovojnica koja se naziva pleura, a građena je od dva sloja, parijetalnog i visceralnog. Između dva lista pleure nalazi se mala količina surfaktanta koja olakšava proces disanja. U patološkom stanju taj potencijalni prostor može biti ispunjen zrakom, razvija se pneumotoraks i pluće kolabira. Količina zraka u pleuralnom prostoru određuje veličinu pneumotoraksa i njegovu malignost. Od posve malih i asimptomatskih, do velikih koji pritišću kolabirano pluće, te dovode do razvoja dispneje i nagle boli u grudima. Prema mehanizmu nastanka pneumotoraks djelimo na spontani i traumatski. Kada spontano nastane u potpuno zdrave osobe nazivamo ga primarni spontani pneumotoraks. Ukoliko je osoba ranije bolovala od neke plućne bolesti govorimo o sekundarnom spontanom pneumotoraksu, koji je najčešće i komplikacija te iste bolesti. Traumatski pneumotoraks nastaje kod penetrantnih ozljeda pluća i zatvorenih povreda plućnog parenhima ili traheobronhalnog stabla. Posebnu pozornost treba obratiti na tenzijski pneumotoraks kao stanje koje može dovesti do kardiopulmonalne insuficijencije, te posljedično smrti pacijenta u svega nekoliko minuta. U ovoj situaciji nalaže se hitna dekompresija iglom ili kateterom. Pneumotoraks dijagnosticiramo temeljem anamneze i fizikalnog nalaza uz pomoć RTG snimaka i CT-a. Liječenje ima za cilj evakuaciju zraka iz pleuralnog prostora i sprječavanje njegovog povratka. Svaki pneumotoraks iziskuje zasebni pristup i odabir najbolje metode liječenja. Terapijske mogućnosti variraju od opservacije, drenaže pa sve do kiruških zahvata. U svrhu sprječavanja recidiva resekcijske tehnike kombiniraju se sa metodama trajne obliteracije, pleurodezama.Lungs are covered with thin invaginated sac called pleura, which is built from two layers, parietal and visceral. Between those two layers we can find small amount of liquid which facilitates the process of breathing. In pathological condition this potential space can be fulfilled with air, which cause pneumothorax and lung collapse. Amount of air in pleural space determinates largeness of pneumothorax and it´s malignancy. From very little and asymptomatic, till severely large which puts pressure on collapsed lung and cause dyspnea and sudden chest pain. According to mechanism of genesis we can divide pneumothorax on spontaneous and traumatic. When it occurs spontaneously in absolutely healthy person we call it primary spontaneous pneumothorax. If person before suffered from any lung disease we talk about secondary spontaneous pneumothorax, which is mostly a complication of that same disease. Traumatic pneumothorax occurs in penetrating injuries and closed trauma of lungs parenchyma or tracheobronchial tree. Special attention must be referred when it comes to tension pneumothorax, because this condition can lead to cardiopulmonary arrest and consequently to death of patient in only few minutes. In this situation it´s required to promptly decompress the lung with needle or catheter. We can diagnose pneumothorax based on anamnesis and physical findings with the help of an RTG scanning and CT. Treatment for the tasks has to evacuate the air from pleural space and to prevent it´s recidivism. Each pneumothorax requires individual access and best choice of method to cure it. Therapical possibilities vary from observation, aspiration to surgical operation. In purpose to prevent recidives we combine resection surgery with methods of permanent obliteration, pleurodesis