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Zentralbl Chir 2018; 143(03): 259-269
DOI: 10.1055/s-0043-119896
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Komplikationsmanagement der Pankreasanastomose

Management of Complications of Pancreatic Anastomoses
Georg F. Weber
1   Chirurgische Klinik, Universitätsklinikum Erlangen, Deutschland
,
Axel Schmid
2   Radiologie, Universitätsklinikum Erlangen, Deutschland
,
Michael Uder
2   Radiologie, Universitätsklinikum Erlangen, Deutschland
,
Robert Grützmann
1   Chirurgische Klinik, Universitätsklinikum Erlangen, Deutschland
› Author Affiliations
Further Information

Publication History

Publication Date:
10 November 2017 (online)

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Zusammenfassung

Hintergrund Die Pankreasanastomose gilt als die Achillesferse der Pankreaschirurgie. Durch die Ausbildung einer postoperativen Pankreasfistel (POPF) kommt es häufig zu mittel- bis schwergradigen, teilweise lebensbedrohlichen Folgekomplikationen.

Fragestellung Möglichkeiten der Prophylaxe, Diagnostik und Therapie der POPF und der POPF-assoziierten Komplikationen im interdisziplinären Management.

Ergebnisse Aktuelle Studienergebnisse zeigen, dass je nach Einteilung der POPF in Grad A – C unterschiedliche diagnostische und therapeutische Maßnahmen die Morbidität und Mortalität senken. Je nach Zeitpunkt und Schweregrad der POPF sowie der POPF-assoziierten Komplikationen ist ein konservatives/interventionelles Management oder chirurgisches Vorgehen indiziert.

Schlussfolgerung Durch die präzise Einteilung der POPF und der POPF-assoziierten Folgekomplikationen kann durch ein gezieltes interdisziplinäres diagnostisches und therapeutisches Vorgehen die Morbidität und Mortalität nach Pankreasoperationen gesenkt werden.

Abstract

Background The pancreatic anastomosis may be the Achilles heel in pancreatic surgery. When a postoperative pancreatic fistula develops, be it mild or severe, in some cases life-threatening, POPF-associated complications can occur.

Objectives Possibilities for the prophylaxis, diagnosis and therapy of POPF and POPF-associated complications in an interdisciplinary setting.

Results Differentiated diagnostic and therapeutic management of POPF grade A – C is supported by recent studies to reduce morbidity and mortality. Depending on time and severity of POPF and POPF-associated complications, a conservative/interventional or surgical approach is indicated.

Conclusion With the precise classification of POPF and POPF-associated complications, interdisciplinary diagnostic and therapeutic management can reduce morbidity and mortality after pancreatic surgery.

Schlüsselwörter

postoperative Pankreasfistel (POPF) - Hämorrhagie - Angiografie - PTCD - Pankreaschirurgie

Key words

postoperative pancreatic fistula (POPF) - hemorrhage - angiography - PTCD - pancreas surgery
 

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