Management von Komplikationen nach Leberresektionen

Zusammenfassung

Leberresektionen haben sich bei malignen oder benignen Lebertumoren zu Standardverfahren mit sehr guten Ergebnissen entwickelt. Es gibt ­jedoch typische postoperative Komplikationen, mit denen sich der hepatobiliäre Chirurg aus­einandersetzen muss. Neben häufigen Komplikationen wie Galleleckagen und Wundheilungs­störungen finden sich auch seltenere Probleme wie Leberversagen oder Gefäßkomplikationen. Die Mortalität und Morbidität nach Leber­teil­resek­tionen ist abhängig vom Allgemeinzustand des Patienten sowie dem Zustand der Leber vor der Resektion, dem perioperativen Management und dem verbleibenden Lebervolumen. Für das postoperative Leberversagen sollte am ehesten im Sinne einer Risikostratifikation eine Präven­tion betrieben werden. Für die Behandlung der anderen Komplikationen bemüht man sich über konservative und „minimalinvasive“ Strategien je nach Behandlungserfolg um eine angepasste Eska­lationsstrategie. 

Abstract

Hepatic resections represent a standard proce­dure for both benign and malignant liver diseases. Nevertheless, typical complications arise follow­ing hepatic surgery. Besides common problems, such as bile leakage or impaired wound healing, rare complications, like progressive liver failure or portal vein thrombosis are observed. Mortality and morbidity after liver resection depend on the preoperative constitution of the patient, on the state of the liver parenchyma and on the re­main­ing liver volume. In particular, a marked steatosis increases both morbidity and mortality of hepatic resections. The advances of modern chemother­apy increases the number of surgical patients, who were previously not resectable. However, the chemotherapy induced hepatotoxicity implies additional problems, thus increasing the morbid­ity of liver resections. Therefore, before planning hepatic surgery, the individual situation of the patient has to be evaluated in order to maximise the security of the operative procedure. 

Schlüsselwörter

Leberchirurgie - postoperative Komplikation - Risikomanagement

Key words

liver resection - postoperative complication - risk management

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