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Viszeralchirurgie 2004; 39(2): 122-128
DOI: 10.1055/s-2004-818745
Originalarbeit

© Georg Thieme Verlag Stuttgart · New York

Therapiemöglichkeiten beim Leberversagen

Therapy of Hepatic FailureM. R. Schön1 , H. L. Tillmann2 , J. Hauss1
  • 1Abteilung für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universität Leipzig
  • 2Medizinische Klinik und Poliklinik II, Universität Leipzig
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Publication History

Publication Date:
21 April 2004 (online)

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Zusammenfassung

Trotz verbesserter Kenntnisse lässt sich ein Leberversagen im Rahmen von Leberteilresektionen nicht immer verhindern. In diesen Situationen sind die Therapiemöglichkeiten begrenzt. Neben klassischen konservativen Verfahren, werden in letzter Zeit zunehmend Leberersatzverfahren angewendet und verbessert.

Im Wesentlichen können drei Gruppen von Verfahren unterschieden werden: Ein der Dialyse ähnliches physikalisches Verfahren, das bereits ca. 10 000-mal zum Einsatz kam, dessen Stellenwerte in der Behandlung des Leberversagens jedoch noch zu untermauern ist. Ein weiteres Verfahren basiert auf hybrider Leberunterstützung, wobei isolierte Hepatozyten extrakorporal eine Entgiftung gewährleisten sollen. Schließlich die extrakorporale Leberperfusion, die den Vorteil einer Galleexkretion erbringen kann.

Wegen der hohen Regenerationskapazität der Leber würden diese Leberersatzverfahren nur für eine beschränkte Zeit benötigt werden.

Abstract

There has been tremendous improvement in the past concerning the prevention of liver failure after liver resections. Still this can not be achieved in all cases. Treatment options are still quite limited. Besides classical conservative treatment, liver assist devices are being investigated.

Mainly three different approaches can be distinguished. First, a physical system, similar to dialysis, but with the addition of albumin, enabling clearance of albumin bound compounds. Second, a system using isolated hepatocytes, which shall lead to detoxification and ideally to some extend of liver synthesis. Finally, extracorporeal perfusion of whole livers is carried out, which potentially has the advantage of producing bile and thereby clearing toxic substances.

As the liver has great potential to regenerate such systems would probably only be required for a limited time period.

Schlüsselwörter

Leberversagen - Leberteilresektion - Leberersatzverfahren - MARS - Hybride Leberunterstützungssysteme - Extrakorporale Leberperfusion

Key words

Liver failure - liver resection - liver assist device - MARS - bioreactor - extracorporeal liver perfusion

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PD Dr. Michael R Schön

Abteilung für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie

Universität Leipzig

Liebigstr. 20

04103 Leipzig

Email: m.schoen@medizin.uni-leipzig.de