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Chirurgische Therapie des Lebertraumas

Resektion – wann und wie?

Surgical treatment of liver trauma

Resection – when and how?

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Zusammenfassung

Sollte nach einem Abdominaltrauma mit Verletzung der Leber ein chirurgisches Vorgehen notwendig sein, ist die Leberresektion während des Notfalleingriffs heute absoluten Ausnahmefällen vorbehalten. In der Regel erfolgt die Therapie konservativ. Nur bei hämodynamischer Instabilität oder progredientem Hämatom ist eine chirurgische Therapie indiziert, die in erster Linie die Blutungskontrolle zum Ziel hat. Während eine anatomische Leberresektion allenfalls bei kompletten Gefäßausrissen indiziert ist, kann beim hämodynamisch stabilen Patienten eine atypische Resektion im Sinne eines Debridements erfolgen. Dieser Artikel soll die Indikation zur Resektion von Lebergewebe nach einem Lebertrauma aus heutiger Sicht beleuchten.

Abstract

Liver resection as an emergency procedure in patients with liver injury due to abdominal trauma has become a rare procedure. In most cases liver trauma can be managed conservatively. Currently surgery is only indicated in hemodynamically instable patients and in cases of progredient haematoma where the main aim is control of bleeding. Anatomical liver resection should be avoided and may only be performed in cases of total vascular avulsion. Debridement of devascularized tissue can also be carried out in terms of an atypical liver resection. This article elucidates the current indications for liver resection after traumatic liver injury.

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  1. Klinik für Allgemein-, Viszeral und Transplantationschirurgie, Ruprecht-Karls-Universität, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland

    H. Bruns, M. von Frankenberg, D. Schultze, M.W. Büchler &  P. Schemmer MBA

  2. Abteilung für Radiodiagnostik, Ruprecht-Karls-Universität, Heidelberg, Deutschland

    B. Radeleff

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  1. H. Bruns
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  2. M. von Frankenberg
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  3. B. Radeleff
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  4. D. Schultze
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  5. M.W. Büchler
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  6. P. Schemmer MBA
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Correspondence to P. Schemmer MBA.

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H. Bruns und M. von Frankenberg sind gleichberechtigte Erstautoren.

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Bruns, H., von Frankenberg, M., Radeleff, B. et al. Chirurgische Therapie des Lebertraumas. Chirurg 80, 915–922 (2009). https://doi.org/10.1007/s00104-009-1729-5

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