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„Small-for-size“

Experimentelle Erkenntnisse für die Leberchirurgie

Small-for-size

Experimental findings for liver surgery

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Zusammenfassung

Die Besonderheit der hepatischen Makrozirkulation, d. h. die parallele portalvenöse und arterielle Blutversorgung, ist von erheblicher Relevanz für die Leberchirurgie. Nach ausgedehnter Hepatektomie oder Transplantation einer größenreduzierten Leber wird das verbleibende oder transplantierte Lebergewebe stärker perfundiert, da die Leber den portalvenösen Einstrom kaum regulieren kann. Diese portale Hyperperfusion ist zum einen für die Induktion der Leberzellproliferation verantwortlich, wird auf der anderen Seite aber als einer der wesentlichen Momente in der Pathogenese des „Small-for-size“-Syndroms gesehen. Die sog. „hepatic arterial buffer response“, womit die semireziproke Beziehung zwischen der Durchblutung der Pfortader und der Durchblutung der Leberarterie beschrieben wird, führt gleichzeitig zu einer arteriellen Minderversorgung der „Small-for-size“-Leber. In diesem Beitrag werden experimentelle und klinische Daten diskutiert, die die hohe aber bislang wenig berücksichtigte Relevanz dieser arteriellen Minderversorgung bei der Entwicklung eines „Small-for-size“-Syndroms unterstreichen.

Abstract

The characteristics of the hepatic macrocirculation, i.e., the parallel portal-venous and arterial blood supply, is of utmost relevance for liver surgery. With extended hepatectomy or transplantation of a reduced-size liver the remaining or transplanted liver tissue is overperfused because the liver fails to regulate the portal-venous inflow. This portal hyperperfusion is responsible for the initiation of liver cell proliferation but represents at the same time one of the substantial events in the pathogenesis of the small-for-size syndrome. Portal-venous hyperperfusion, the so-called hepatic arterial buffer response, which describes the semi-reciprocal relationship between the portal-venous and hepatic arterial blood flows, leads to an arterial hypoperfusion of the small-for-size liver. In this article experimental and clinical data are discussed which underline the high but so far overseen relevance of this arterial underperfusion in the development of a small-for-size syndrome.

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  1. Institut für Experimentelle Chirurgie, Universität Rostock, Schillingallee 69a, 18055, Rostock, Deutschland

    C. Eipel, K. Abshagen & B. Vollmar

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  1. C. Eipel
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Eipel, C., Abshagen, K. & Vollmar, B. „Small-for-size“. Chirurg 83, 238–246 (2012). https://doi.org/10.1007/s00104-011-2179-4

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