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Management intra- und postoperativer Blutungen in der Leberchirurgie

Management of intraoperative and postoperative bleeding in liver surgery

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Zusammenfassung

Das Management von Blutungen in der Leberchirurgie erfolgt multidisziplinär. Traumatische Leberverletzungen können meist konservativ behandelt werden. Die chirurgische Therapie des schweren Lebertraumas ist aufgrund der ausgedehnten Parenchym- und Gefäßverletzung mit einer hohen Mortalität behaftet. Elektive Leberresektionen können aufgrund fundierter Kenntnisse der Leberanatomie und aufgrund verfeinerter Resektionstechniken in der Regel mit herabgesetztem Blutungsrisiko durchgeführt werden. Dennoch sind Blutverlust und Transfusionsbedarf bei erweiterten Resektionen ein wesentlicher Faktor, der Morbidität und Mortalität beeinflusst. Die perioperative Senkung des zentralvenösen Drucks und die Reduktion der Leberperfusion durch selektive Einflusskontrolle oder totale vaskuläre Exklusion sind effektive Methoden, um den Blutverlust weiter zu reduzieren. Der Einsatz moderner Geräte für die Parenchymdissektion ermöglicht dem Chirurgen zudem ein blutungsarmes Operieren.

Abstract

The management of bleeding in liver surgery is multidisciplinary. In most cases traumatic liver injury can be treated conservatively. Surgical treatment of severe liver trauma is associated with a high mortality rate due to extensive parenchymal and vascular injury as well as blood loss associated with the trauma. Fundamental knowledge of liver anatomy and refined surgical techniques help to reduce intraoperative blood loss and improve outcomes in elective liver surgery; nevertheless, severe blood loss and augmented transfusion requirements during extensive liver resection are still key factors for increased morbidity and mortality. Intraoperative lowering of central venous pressure and selective hepatic inflow occlusion or even total hepatic vascular exclusion are effective means of further reducing intraoperative blood loss. Furthermore, the application of sophisticated surgical instruments provides the surgeon with the potential to operate without the requirement of additional blood transfusions.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. R. Sucher, D. Seehofer und J. Pratschke geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinik für Allgemein-, Visceral- und Transplantationschirurgie, Charité – Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburgerplatz 1., 13353, Berlin, Deutschland

    R. Sucher, D. Seehofer & J. Pratschke

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  1. R. Sucher
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  3. J. Pratschke
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Correspondence to R. Sucher.

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Sucher, R., Seehofer, D. & Pratschke, J. Management intra- und postoperativer Blutungen in der Leberchirurgie. Chirurg 86, 114–120 (2015). https://doi.org/10.1007/s00104-014-2879-7

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