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Vaskuläres Management bei anatomischen Leberresektionen

Vascular management in anatomical liver resection

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Zusammenfassung

Das vaskuläre Management bei anatomischen Leberresektionen ist entscheidend für die Erhaltung von ausreichend funktionellem Restlebervolumen. D. h. ein Leberlappen oder mehrere Lebersegmente brauchen einen suffizienten arteriellen und portal venösen Inflow und eine ausreichende venöse Drainage. Um dies zu erreichen, bedarf es einer ausgezeichneten präoperativen Bildgebung, entsprechende chirurgische Expertise mit Kenntnis der Anatomie, Physiologie, der Hämodynamik und ein bedachtes, vorsichtiges Vorgehen. Ebenso empfiehlt es sich, moderne Hilfsmittel der intraoperativen Diagnostik (i. e. intraoperative Sonographie mit Kontrastmittelverstärkung) und Parenchymdurchtrennung zu nutzen.

Abstract

The vascular management in anatomical liver resection plays a pivotal role in maintaining an adequately functional residual liver volume. In this respect it is essential to guarantee an adequate portal and arterial inflow as well venous outflow for the whole residual liver (lobe or segments). To achieve this, the liver surgeon should have excellent perioperative imaging, surgical expertise based on knowledge of vascular anatomy, physiology and hemodynamics of the liver and a well-designed and cautious operative strategy. The use of intraoperative ultrasonography (with or without contrast enhancement) and modern parenchymal dissectors (e.g. ultrasound or water jet dissectors) are strongly recommended.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. S. Nadalin, I. Capobianco und A. Königsrainer geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Allgemeine, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen, Hoppe Seyler Str. 3, 72076, Tübingen, Deutschland

    S. Nadalin, I. Capobianco &  A. Königsrainer

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  1. S. Nadalin
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  2. I. Capobianco
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  3. A. Königsrainer
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Correspondence to A. Königsrainer.

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Nadalin, S., Capobianco, I. & Königsrainer, A. Vaskuläres Management bei anatomischen Leberresektionen. Chirurg 86, 121–124 (2015). https://doi.org/10.1007/s00104-014-2882-z

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