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Leber- und iatrogene Gallenwegverletzungen

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Akutes Abdomen

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Zusammenfassung

Bei der Diagnostik und der Therapie des Lebertraumas kommt es v. a. auf den Verletzungsgrad und die Begleitverletzungen an. Ein Großteil kann heutzutage konservativ behandelt werden, wobei intensivmedizinische Observanz und engmaschiges Monitoring mit Ultrasonographie/Computertomographie unabdingbare Voraussetzungen sind. Ein operatives Vorgehen ist insbesondere bei zunehmender hämodynamischer Instabilität notwendig. In sehr schweren Fällen lassen sich die Überlebensraten durch primäres Packing und Definitivversorgung nach Kreislaufstabilisierung und Gerinnungsoptimierung steigern. Die iatrogene Gallenwegläsion bleibt trotz eines rückläufigen Trends bestimmender Faktor für die Morbidität der laparoskopischen Cholezystektomie. Die Versorgung sollte an spezialisierten hepatobiliären Zentren erfolgen. Vielfach sind jüngere Menschen betroffen, deren Lebensqualität und Lebenserwartung bei nichtadäquater Behandlung durch Langzeitschäden wie Cholangitis und sekundäre biliäre Zirrhose negativ beeinflusst wird. In den meisten Fällen ist die Rekonstruktion mittels Hepatikojejunostomie zu bevorzugen.

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Authors and Affiliations

  1. Universitätsklinik für Chirurgie, Auenbruggerplatz 29, A-8036, Graz

    o. Univ.-Prof. Dr. med. Hans-Jörg Mischinger

  2. Klinische Abteilung für Allgemeinchirurgie, Medizinische Universität Graz, Auenbruggerplatz 29, A-8036, Graz

    Priv.-Doz. Dr. med. Doris Wagner

  3. Chirurgische Universitätsklinik, Medizinische Universität Graz, Auenbruggerplatz 29, A-8036, Graz

    Univ.-Prof. Dr. med. Herwig Cerwenka

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  1. o. Univ.-Prof. Dr. med. Hans-Jörg Mischinger
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  2. Priv.-Doz. Dr. med. Doris Wagner
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  3. Univ.-Prof. Dr. med. Herwig Cerwenka
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Editors and Affiliations

  1. LKH Graz Süd-West, Chirurgie, Graz, Österreich

    Hubert Hauser

  2. DGAV e.V., Berlin, Deutschland

    Heinz Johannes Buhr

  3. Universitätsklinik für Chirurgie, Graz, Österreich

    Hans-Jörg Mischinger

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Mischinger, HJ., Wagner, D., Cerwenka, H. (2016). Leber- und iatrogene Gallenwegverletzungen. In: Hauser, H., Buhr, H., Mischinger, HJ. (eds) Akutes Abdomen. Springer, Vienna. https://doi.org/10.1007/978-3-7091-1473-5_19

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  • DOI: https://doi.org/10.1007/978-3-7091-1473-5_19

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