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Intraoperative Komplikationen bei Operationen im Halsbereich

Intraoperative complications of neck surgery

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Zusammenfassung

Intraoperative Komplikationen im Halsbereich sind selten und selten lebensbedrohlich. Ihre Vermeidung beruht auf exakter anatomischer Kenntnis und sorgfältiger Präparation. Die Schädigung des N. recurrens ist bei Lagevarianten (nonrekurrent, frühe Aufzweigung) erhöht. Das intraoperative Neuromonitoring (IONM) kann die bilaterale Parese verhindern. Bei akzidenteller Verletzung kann die primäre Nervennaht die Stimmbandfunktion verbessern. Die Autotransplantation von Nebenschilddrüsen kann die Rate an Hypoparathyreoidismus senken, sie kann als Routinemaßnahme nach Datenlage aber nicht gefordert werden. Intraoperative Blutungen in der Halschirurgie sind in der Regel gut zu beherrschen. Größere Gefahr für den Patienten geht von der früh-postoperativen Blutung aus. Zu ihrer Vermeidung können vielfältige Techniken zielführend sein (Naht, Clips, „vessel sealing“). Verletzungen des Ductus thoracicus werden mit Naht, Ligatur oder Clip versorgt. Kleinere Verletzungen von Trachea und Ösophagus können durch Naht oder Muskellappenplastik behoben werden. Bei großen Verletzungen bedarf es der plastischen Rekonstruktion oder Resektion ggf. mit Organersatz.

Abstract

Intraoperative complications of neck surgery are uncommon and rarely life-threatening and exact anatomical knowledge and precise dissection are most important for prevention. Anatomical variants (e.g. non-recurrent nerve, extralaryngeal branching) predispose to damage of the recurrent laryngeal nerve. The use of intraoperative neuromonitoring (IONM) can prevent bilateral nerve damage but in cases of accidental nerve damage primary reconstruction can improve vocal cord function. Autotransplantation of parathyroid tissue can reduce the rate of hypoparathyroidism but cannot be postulated as a routine measure. Intraoperative bleeding can usually be well controlled and greater danger for the patient emanates from early postoperative bleeding for which many techniques (clip, ligature, vessel sealing) can be employed for prevention. Lesions of the thoracic duct can be controlled by clip, ligation or stitch. Smaller lesions of the trachea and esophagus can be secured with direct suture or muscle flap plasty. In cases of larger lesions plastic reconstruction or organ replacement can be necessary.

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  1. Klinik für Allgemein- und Viszeralchirurgie, Evangelisches Krankenhaus Bethesda zu Duisburg GmbH, Heerstr. 219, 47053, Duisburg, Deutschland

    D. Simon, M. Lassau, P. Schmidt-Wilcke & M. Boucher

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  1. D. Simon
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  2. M. Lassau
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  3. P. Schmidt-Wilcke
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  4. M. Boucher
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Correspondence to D. Simon.

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Simon, D., Lassau, M., Schmidt-Wilcke, P. et al. Intraoperative Komplikationen bei Operationen im Halsbereich. Chirurg 83, 626–632 (2012). https://doi.org/10.1007/s00104-011-2210-9

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  • DOI: https://doi.org/10.1007/s00104-011-2210-9

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