Zusammenfassung
Leberverletzungen können sowohl isoliert oder im Rahmen von Polytraumata auftreten. Indikationen zur umgehenden chirurgischen Versorgung sind kreislaufinstabile Patienten mit dem Nachweis von freier intraabdomineller Flüssigkeit in der Bildgebung. Für diese Patienten wurde ein „Damage-control-Konzept“ zur Senkung der Frühmortalität nach Trauma entwickelt. Dabei unterbleiben aufwendige rekonstruktive Eingriffe in der Initialphase. Kernpunkt dieses Therapieverfahrens ist die Stabilisierung des Patienten durch Therapie der „tödlichen Trias“ bestehend aus Hypothermie, Koagulopathie und metabolischer Azidose. Gegebenfalls notwendige Rekonstruktionen oder andere größere Operationen erfolgen nach Stabilisierung des Patienten im Intervall. Das „packing“ zur temporären Versorgung von Leberverletzungen ist Bestandteil des Damage-control-Konzepts.
Abstract
Liver injuries may occur alone as well as within the broader context of polytrauma. Immediate surgical intervention is indicated in hemodynamically instable patients with detection of free intra-abdominal fluid as demonstrated by imaging studies. For these patients, a damage control concept has been devised in order to decrease early mortality after trauma. With this strategy complex reconstructive interventions are avoided during the initial phase. Stabilization of the patient by treatment of the lethal triad consisting of hypothermia, coagulopathy and metabolic acidosis is at the core of this therapeutic concept. Should there be a need for reconstructions or other major surgical interventions these will be performed with delay after stabilization of the patient. Packing for the temporary treatment of liver injuries is part of the damage control concept.
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Rauchfuß, F., Voigt, R., Götz, M. et al. Damage-control-Konzept bei Leberverletzungen. Chirurg 80, 923–928 (2009). https://doi.org/10.1007/s00104-009-1728-6
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DOI: https://doi.org/10.1007/s00104-009-1728-6