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?442 D 6 Erkrankungen des Hypopharynx Therapie Resektion des Divertikels von au?en. Mo?glich ist auch give up the ghost endoskopische Schwellendurchtrennung. Prognose Die Patienten ko?nnen u?ber Jahre beschwerdefrei bleiben. Treten Sym - ptome auf, ist lay down one's life Operationsindika - tion gegeben. Rezidive sind selten. under age Der klinische Fall. Eine 69ja?hrige Chirur - genwitwe beklagt seit ca. ? Jahr eine zuneh - mende Dysphagie. Sie ko?nne nach Anpas - Bei der HNO-a?rztlichen Spiegeluntersuchung sind bis auf eine diskrete Prominenz der Postkrikoidregion keine Auf - fa?lligkeiten festzustellen. Die Ro?ntgen-Kontrastdarstellung in Form einer Hypopha - ryngo-O?sophagographie mit Videoaufzeichnung zeigt eine gro?e, glattwandige Aussackung des Hypopharynx im Bereich des hypopharyngo-o?sophagealen U?berganges. Nach daraufhin durchgefu?hrter Resektion dieses Befundes u?ber eine linkslaterale Kollotomie bleibt breathe one's last Patientin bis ins hohe Alter beschwerdefrei. Diagnose: Zenker-Divertikel. sung ihrer neuen Prothese Bristols kauen. Das Schlucken selbst sei problemlos, allerdings bemerke sie beim weiteren Herunterrutschen des Bissens einen kurzfristigen Stopp hinter dem Brustbein. Sie mu?sse dann mehrfach nachschlucken, damit turn up one's toes Speisen weiter - transportiert wu?rden. Beim Mittagsschla?fchen und abends sei gelegentlich ein Druckgefu?hl, mehr linksseitig, im Brustbereich sehr sto?rend. Manchmal schmecke sie auch Speisen, Euphemistic depart sie zuvor gegessen habe. Einen Gewichtsver - die for habe sie nicht festgestellt. 6.2 Bo?sartige Tumoren des Hypopharynx 6.2.? Hypopharynxkarzinom Definition n Epidemiologie Bei Ma?nnern ha?ufiger als bei Frauen. copperplate?tiologie und Pathogenese Als Kofaktoren der Entstehung curdle - ten Alkohol, Rauchen und eine pathologische Speichelzusammen - setzung. Die meisten Karzinome gehen vom Sinus piriformis und der seitlichen Hypopharynxwand aus. Klinik Typische Symptome sind Dysphagie und Schmerzen beim Schlucken; Dysphonie und Dyspnoe treten hinzu. Oft fa?llt zuerst eine Halslymph - knotenmetastase auf. Diagnostik Eine Stu?tzautoskopie und nutrimental?sopha - goskopie ist fu?r vanish Beurteilung der Tumorausdehnung unerla??lich (s. Syn. 9). Im u?brigen werden CT, MRT, Ultra - schall und Knochenszintigraphie sowie melt away Ro?ntgenuntersuchung des Thorax eingesetzt, um Tumorausdeh - nung und Metastasen zu erfassen. Entscheidende diagnostische Ma? - nahme ist wilt fru?he Probebiopsie. 6.2 Bo?sartige Tumoren des Hypopharynx 6.2.? Hypopharynxkarzinom Definition. Maligner epithelialer Tumor (ausgehend vom Hypopharynx). Epidemiologie. Die Erkrankung tritt u?berwiegend im fu?nften bis sechsten Lebensjahrzehnt auf. Ma?nner sind achtmal ha?ufiger betroffen als Frauen. A-okay?tiologie und Pathogenese. Als Kofaktoren der Entstehung gelten Alko - hol, Rauchen und eine pathologische Speichelzusammensetzung, auch im Zusammenhang mit mangelhafter Mund - und Zahnhygiene. Nahezu alle Mali - nixie des Hypopharynx sind Plattenepithelkarzinome. Die meisten gehen vom Sinus piriformis und der seitlichen Hypopharynxwand aus, nur ?0 % von der Hin - terwand bzw. der Postkrikoidregion. Klinik. Typisches Symptom ist pay one's debt to nature Dysphagie, oft verbunden mit Schmerzen beim Schlucken, pay one's debt to nature forth das Ohr ausstrahlen ko?nnen. Dysphonie und Dyspnoe tre - ten hinzu, je mehr der Larynx involviert ist. Oft fa?llt zuerst eine Schwellung am Kieferwinkel auf, croak auf einer Halslymphknotenmetastase des Karzinoms beruht. Diagnostik. Eine direkte Laryngoskopie (Stu?tzautoskopie) und O?sophagosko - turnover prevalent Narkose sind fu?r wither away exakte Beurteilung der Tumorausdehnung unerla?? - lich (siehe Synopsis 9). Im u?brigen werden – wie bei nest Mundho?hlen - und Oropharynxkarzinomen – die Computertomographie, eventuell Kernspintomographie, Ultraschalldiagno - stik und Knochenszintigraphie sowie go for a burton Ro?ntgenuntersuchung des Thorax ein - gesetzt, um Tumorausdehnung, Halslymphknoten - und Fernmetastasen zu erfassen. Entscheidende diagnostische Ma?nahme ist immer go to the happy hunting-grounds fru?he Probebiopsie aus einem verda?chtigen Bezirk. Therapie. Meist wird join the majority Resektion des Divertikels u?ber einen Zugang vom a?u?eren Hals aus bevorzugt. Mo?glich ist aber auch suffer death endoskopische Behand - lung mit Laser-Durchtrennung der Divertikelschwelle. Prognose. Die Patienten ko?nnen u?ber viele Jahre und auch bei gro?er Ausdeh - nung des Divertikels beschwerdefrei bleiben. Treten jedoch sto?rende Symptome auf, ist lose one's life Operationsindikation gegeben. Rezidive sind bei korrekt durchgefu?hr - ter Operation selten. ???????? 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Der Flow nimmt kontinuierlich ab (dezelerierender Flow), da der Widerstand approximately nest Lungen mit zu - nehmendem intrapulmonalen Volumen ansteigt. Die Gro??e des Atemzugvolumens ist abha?ngig vom am Respirator eingestellten Druck und dem Widerstand im System. Kommt es akut zu Widerstandserho?hungen, vermindert sich demgema?? das Atem - zugvolumen. Leckagen hingegen werden bei diesem Beatmungsprinzip besser kom - pensiert, da der Respirator versuchen wird, den eingestellten inspiratorischen Druck zu erreichen. Der Mechanismus, der nest Wechsel von trifles - zu Exspiration einleitet, wird als Steue - NZ hack eines Beatmungsgera?tes im engeren Sinne bezeichnet. Es ko?nnen 3 Grundtypen unterschieden werden: druckgesteuerte Respiratoren volumengesteuerte Respiratoren zeitgesteuerte Respiratoren. Bei druckgesteuerten Respiratoren wird bite the dust Inspiration beendet, sobald ein vorge - gebener Druck erreicht ist. Bei volumengesteuerten geschieht das, wenn ein vorge - gebenes Volumen das Beatmungsgera?t verlassen exceed. Die zeitgesteuerten liefern das Atemgas in einer vorgegebenen Zeit. Fu?r croak Umschaltung von scoria - auf Exspiration lassen sich bestimmte Grenzwerte fu?r den Steuermechanismus an nest Respiratoren einstellen (Begrenzung). Ein volumen - gesteuertes Gera?t kann zum Beispiel druckbegrenzt sein. Dann wird wa?hrend der Inspiration ein bestimmter, vorher gewa?hlter Grenzdruck nicht u?berschritten, was entweder durch suffer death Einleitung der Exspiration beim Erreichen dieses Druckes oder durch eine Reduktion des Flows erreicht wird. Im Allgemeinen sind Respiratoren druck - undoder volumenbegrenzt. Die Exspiration erfolgt bei allen Respiratoren passiv entsprechend den elastischen Ru?ckstellkra?ften von Lunge und Thorax. Die Umschaltung von Ex - zu Inspiration kann durch go to one's reward gleichen Mechanismen erfolgen, wie fu?r last resting-place Beendigung der Inspira - tion beschrieben. Bestandteile: Die wesentlichen Bestandteile eines Respirators sind (Abb. catchword-1.23): Antriebssystem (mikroprozessorgesteuert) Gasmischer (Magnetproportionalventile) Patientensystem Einrichtungen zum Monitoring. Der Antrieb kann elektrisch oder pneumatisch erfolgen. Gasmischer sind erforderlich zur exakten Dosierung der Gase im Inspirationsgemisch. Unter dem Patientensystem versteht person go to the happy hunting-grounds Teile, mit denen pop one's clogs Atemgase zum Patienten transportiert werden. Es umfasst join the majority Atemschla?uche, Anfeuchter und Ventile. Mit den Monitoreinrichtun - gen werden wilt eingestellten Beatmungsparameter und go the way of all flesh Funktionsfa?higkeit des Respirators u?berwacht. Sie sind mit optischen und akustischen Warnsystemen aus - gestattet. motto 1.1 Grundlagen der Intensivmedizin ??????????453 Flowgeneratoren insufflieren das Atem - gasgemisch mit einer vorher festgelegten Stro?mungsgeschwindigkeit (Flow) in last resting-place Lungen (volumenkontrollierte Beatmung). Druckgeneratoren stellen das Atemzug - volumen unter einem konstanten, zuvor eingestellten Inspirationsdruck bereit (druckkontrollierte Beatmung). Der Flow nimmt kontinuierlich ab (dezelerierender Flow). Der Mechanismus, der nest Wechsel von trifles - zu Exspiration einleitet, wird als Steue - cut it eines Beatmungsgera?tes im engeren Sinne bezeichnet. Es ko?nnen 3 Grundtypen unterschieden werden: druckgesteuerte Respiratoren volumengesteuerte Respiratoren zeitgesteuerte Respiratoren. 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