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Die Duplexsonographie der Leber und des Pfortadersystems

Duplex ultrasound of hepatic and portal veins

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Zusammenfassung

□ Die Duplexsonographie ermöglicht die Beurteilung der Hämodynamik des gesamten portalvenösen und Lebervenengefäßsystems. Die Methode ist etabliert als „noninvasive Splenoportographie” und hat einen hohen diagnostischen Rang durch frühzeitigen und schnellen Nachweis von Pfortader- und Milzvenenthrombosen, dem Budd-Chiari-Syndrom, der Darstellung portosystemischer Kollateralen und Veränderungen der Strömungsrichtung in der Pfortader.

□ Neben diesen qualitativen Befunden gewinnt die quantitative Duplexsonographie durch Ermittlung der portalvenösen Blutströmungsgeschwindigkeit zur Abschätzung der portalen Hypertonie und des Blutungsrisikos aus Ösophagusvarizen zunehmende klinische Bedeutung. Daneben liefert sie wertvolle Hinweise in der Therapieüberwachung der medikamentösen Blutungsprophylaxe.

□ Zur Verlaufskontrolle nach portokavalen Shunt-Operationen und intrahepatischer Stent-Einlage eignet sich das Verfahren ebenso wie zur Diagnose vaskulärer Transplantatdysfunktionen. Darüber hinaus erlangt die Duplexsonographie klinische Bedeutung in der Diagnose und Therapiekontrolle akuter Lebertransplantatabstoßungen.

□ Bei der Tumordiagnostik liegt ihr Wert im präoperativen Staging, sie liefert außerdem differentialdiagnostische Hinweise anhand von Perfusionsmustern.

Abstract

□ Duplex ultrasound allows direct access to portal venous and hepatic vein hemodynamics. This method has been accepted as a reliable procedure to detect portal and splenic venous thrombosis, Budd-Chiari’s syndrome, portosystemic collateralisation and changes in the portal venous blood flow direction with a high rate of sensitivity.

□ Besides these qualitative findings Doppler flowmetry allows quantitative measurement of portal venous blood flow velocities. The estimation of portal hypertension and the prediction of the risk of variceal bleeding by quantitative Doppler flowmetry is of increasing clinical importance. In monitoring the efficiency of medicational prophylaxis against gastrointestinal bleeding is also helpful.

□ Duplex ultrasound can be used to evaluate the function of portocaval shunts including the intrahepatic stent shunt as well as to detect vascular complications after liver transplantation. Furthermore the method is gaining importance in the diagnosis and monitoring of therapy of acute liver transplant rejection.

□ In case of liver tumors duplex ultrasound is of value for tumor staging and provides information about the dignity on the basis of perfusion patterns.

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Authors and Affiliations

  1. Abteilung I-Innere Medizin/Gastroenterologie, Bundeswehrzentralkrankenhaus, Rübenacherstraße 170, D-56072, Koblenz

    Hans-H. Mohr

  2. Medizinische Klinik und Poliklinik der Johannes-Gutenberg, Universität Mainz, Mainz, Deutschland

    Werner Gödderz & Karl-Hermann Meyer zum Büschenfelde

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Mohr, HH., Gödderz, W. & Meyer zum Büschenfelde, KH. Die Duplexsonographie der Leber und des Pfortadersystems. Med Klin 93, 669–677 (1998). https://doi.org/10.1007/BF03044879

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