2024-
2025
Thoraxheelkunde
PROF DR DE LEYN
JOZEFIEN CEULEMANS
,Aandoeningen van de pleura, thoraxwand en diafragma ....................................................... 5
Pneumothorax ........................................................................................................................ 5
3 types ................................................................................................................................ 5
Symptomen ........................................................................................................................ 5
Klinisch onderzoek.............................................................................................................. 5
Diagnose ............................................................................................................................. 6
Spanningspneumothorax ................................................................................................... 6
Primaire spontane pneumothorax ..................................................................................... 6
Oorzaak........................................................................................................................... 6
Behandeling .................................................................................................................... 6
Indicatie voor ingreep .................................................................................................... 6
Secundaire pneumothorax ................................................................................................. 7
Catameniale pneumothorax .......................................................................................... 7
Traumatische pneumothorax ............................................................................................. 7
Iatrogene pneumothorax ................................................................................................... 7
Casussen ............................................................................................................................. 7
Patiënt 1 ......................................................................................................................... 7
Patiënt 2 ......................................................................................................................... 7
Empyeem ................................................................................................................................ 8
Aanpak ................................................................................................................................ 8
Oorzaak............................................................................................................................... 8
Casus................................................................................................................................... 8
Pleurale tumoren ................................................................................................................... 9
Pleurale metastasen ........................................................................................................... 9
Pleurale plaques ................................................................................................................. 9
Fibreuze pleuratumor......................................................................................................... 9
Mesothelioom .................................................................................................................... 9
Thoraxheelkunde: pleurale tumoren ...................................................................................... 10
Casus..................................................................................................................................... 10
Aangeboren afwijkingen van thoraxwand ........................................................................... 11
Pectus excavatum............................................................................................................. 11
Diagnose ....................................................................................................................... 11
Behandeling .................................................................................................................. 11
Casus............................................................................................................................. 12
Pectus carinatum .............................................................................................................. 12
, Aandoeningen diafragma ..................................................................................................... 12
Diafragmaparalyse ........................................................................................................... 12
Unilaterale diafragmaparalyse ..................................................................................... 12
Bilaterale diafragmaparalyse ....................................................................................... 13
Hernia diafragmatica ........................................................................................................ 13
Neoplasie van long en mediastinum....................................................................................... 14
A. Longtumoren.................................................................................................................... 14
Inleiding en terminologie ..................................................................................................... 14
Prevalentie ........................................................................................................................... 15
Symptomen .......................................................................................................................... 15
Types................................................................................................................................. 16
Nieuwe diagnose van longkanker ........................................................................................ 16
Medische evaluatie .......................................................................................................... 17
Oncologische evaluatie .................................................................................................... 17
Onderzoeken ................................................................................................................ 17
Behandeling van niet-kleincellige longcarcinoom ........................................................... 19
Tabel behandeling NSCLC ............................................................................................. 19
Enkele studies ............................................................................................................... 20
Behandeling kleincellig longcarcinoom ............................................................................ 20
Behandelingsmodaliteiten longkanker ................................................................................ 20
Heelkundige behandeling................................................................................................. 20
Toegang ........................................................................................................................ 21
Types............................................................................................................................. 21
Postoperatieve mortaliteit ............................................................................................... 23
Postoperatieve complicaties ............................................................................................ 23
Atelectase – mucus impactie – pneumonie ................................................................. 23
Arythmie ....................................................................................................................... 24
Broncho-pleurale fistel ................................................................................................. 24
Empyeem ...................................................................................................................... 24
Verlengd luchtlek ......................................................................................................... 25
Prognose ........................................................................................................................... 25
Screening .......................................................................................................................... 25
Nelson trial ................................................................................................................... 25
Coin lesion ............................................................................................................................ 25
Histologie ...................................................................................................................... 26
, Casussen ............................................................................................................................... 27
Patiënt 1 ........................................................................................................................... 27
Patiënt 2 ........................................................................................................................... 28
Patiënt 3 ........................................................................................................................... 28
Longmetastasectomie .......................................................................................................... 28
Symtomen ........................................................................................................................ 29
Diagnose ........................................................................................................................... 29
Indicatie heelkunde .......................................................................................................... 29
Prognostische indicatoren................................................................................................ 29
B. Mediastinale tumoren ..................................................................................................... 29
Opdeling ............................................................................................................................... 29
Kliniek ................................................................................................................................... 30
Diagnose ............................................................................................................................... 30
Voorste mediastinum ....................................................................................................... 30
Thymoma...................................................................................................................... 30
Lymfoom....................................................................................................................... 31
Kiemceltumoren ........................................................................................................... 31
goiter ............................................................................................................................ 32
Middelste mediastinum ................................................................................................... 32
Cyste ............................................................................................................................. 32
Achterste mediastinum .................................................................................................... 32
Neurogene tumoren ..................................................................................................... 32
Mediastinale casus ............................................................................................................... 33
Examen ................................................................................................................................. 33
Functieverbetrende longchirurgie .......................................................................................... 34
Bullectomie........................................................................................................................... 34
Bullectomie....................................................................................................................... 34
Longvolume reductie (LVRS) ................................................................................................ 34
(Contra-)Indicaties ............................................................................................................ 35
Resultaten ........................................................................................................................ 35
Procedure ......................................................................................................................... 35
Longtransplantatie ............................................................................................................... 35
Indicaties .......................................................................................................................... 36
Procedure ......................................................................................................................... 36
Verwikkelingen ................................................................................................................. 36
2025
Thoraxheelkunde
PROF DR DE LEYN
JOZEFIEN CEULEMANS
,Aandoeningen van de pleura, thoraxwand en diafragma ....................................................... 5
Pneumothorax ........................................................................................................................ 5
3 types ................................................................................................................................ 5
Symptomen ........................................................................................................................ 5
Klinisch onderzoek.............................................................................................................. 5
Diagnose ............................................................................................................................. 6
Spanningspneumothorax ................................................................................................... 6
Primaire spontane pneumothorax ..................................................................................... 6
Oorzaak........................................................................................................................... 6
Behandeling .................................................................................................................... 6
Indicatie voor ingreep .................................................................................................... 6
Secundaire pneumothorax ................................................................................................. 7
Catameniale pneumothorax .......................................................................................... 7
Traumatische pneumothorax ............................................................................................. 7
Iatrogene pneumothorax ................................................................................................... 7
Casussen ............................................................................................................................. 7
Patiënt 1 ......................................................................................................................... 7
Patiënt 2 ......................................................................................................................... 7
Empyeem ................................................................................................................................ 8
Aanpak ................................................................................................................................ 8
Oorzaak............................................................................................................................... 8
Casus................................................................................................................................... 8
Pleurale tumoren ................................................................................................................... 9
Pleurale metastasen ........................................................................................................... 9
Pleurale plaques ................................................................................................................. 9
Fibreuze pleuratumor......................................................................................................... 9
Mesothelioom .................................................................................................................... 9
Thoraxheelkunde: pleurale tumoren ...................................................................................... 10
Casus..................................................................................................................................... 10
Aangeboren afwijkingen van thoraxwand ........................................................................... 11
Pectus excavatum............................................................................................................. 11
Diagnose ....................................................................................................................... 11
Behandeling .................................................................................................................. 11
Casus............................................................................................................................. 12
Pectus carinatum .............................................................................................................. 12
, Aandoeningen diafragma ..................................................................................................... 12
Diafragmaparalyse ........................................................................................................... 12
Unilaterale diafragmaparalyse ..................................................................................... 12
Bilaterale diafragmaparalyse ....................................................................................... 13
Hernia diafragmatica ........................................................................................................ 13
Neoplasie van long en mediastinum....................................................................................... 14
A. Longtumoren.................................................................................................................... 14
Inleiding en terminologie ..................................................................................................... 14
Prevalentie ........................................................................................................................... 15
Symptomen .......................................................................................................................... 15
Types................................................................................................................................. 16
Nieuwe diagnose van longkanker ........................................................................................ 16
Medische evaluatie .......................................................................................................... 17
Oncologische evaluatie .................................................................................................... 17
Onderzoeken ................................................................................................................ 17
Behandeling van niet-kleincellige longcarcinoom ........................................................... 19
Tabel behandeling NSCLC ............................................................................................. 19
Enkele studies ............................................................................................................... 20
Behandeling kleincellig longcarcinoom ............................................................................ 20
Behandelingsmodaliteiten longkanker ................................................................................ 20
Heelkundige behandeling................................................................................................. 20
Toegang ........................................................................................................................ 21
Types............................................................................................................................. 21
Postoperatieve mortaliteit ............................................................................................... 23
Postoperatieve complicaties ............................................................................................ 23
Atelectase – mucus impactie – pneumonie ................................................................. 23
Arythmie ....................................................................................................................... 24
Broncho-pleurale fistel ................................................................................................. 24
Empyeem ...................................................................................................................... 24
Verlengd luchtlek ......................................................................................................... 25
Prognose ........................................................................................................................... 25
Screening .......................................................................................................................... 25
Nelson trial ................................................................................................................... 25
Coin lesion ............................................................................................................................ 25
Histologie ...................................................................................................................... 26
, Casussen ............................................................................................................................... 27
Patiënt 1 ........................................................................................................................... 27
Patiënt 2 ........................................................................................................................... 28
Patiënt 3 ........................................................................................................................... 28
Longmetastasectomie .......................................................................................................... 28
Symtomen ........................................................................................................................ 29
Diagnose ........................................................................................................................... 29
Indicatie heelkunde .......................................................................................................... 29
Prognostische indicatoren................................................................................................ 29
B. Mediastinale tumoren ..................................................................................................... 29
Opdeling ............................................................................................................................... 29
Kliniek ................................................................................................................................... 30
Diagnose ............................................................................................................................... 30
Voorste mediastinum ....................................................................................................... 30
Thymoma...................................................................................................................... 30
Lymfoom....................................................................................................................... 31
Kiemceltumoren ........................................................................................................... 31
goiter ............................................................................................................................ 32
Middelste mediastinum ................................................................................................... 32
Cyste ............................................................................................................................. 32
Achterste mediastinum .................................................................................................... 32
Neurogene tumoren ..................................................................................................... 32
Mediastinale casus ............................................................................................................... 33
Examen ................................................................................................................................. 33
Functieverbetrende longchirurgie .......................................................................................... 34
Bullectomie........................................................................................................................... 34
Bullectomie....................................................................................................................... 34
Longvolume reductie (LVRS) ................................................................................................ 34
(Contra-)Indicaties ............................................................................................................ 35
Resultaten ........................................................................................................................ 35
Procedure ......................................................................................................................... 35
Longtransplantatie ............................................................................................................... 35
Indicaties .......................................................................................................................... 36
Procedure ......................................................................................................................... 36
Verwikkelingen ................................................................................................................. 36
