Zusammenfassung
Operative Eingriffe an der Leber sind heute zu einer erfolgreichen Therapie maligner und benigner Erkrankungen der Leber geworden. Trotz Ausdehnung der Indikationsstellung, steigender Invasivität der Eingriffe und zunehmendem Alter der Patienten hat die perioperative Morbidität und Mortalität stetig abgenommen. Ursächlich hierfür sind enorme Fortschritte auf den Gebieten der Chirurgie, der Anästhesie und der postoperativen Intensivmedizin während der letzten beiden Jahrzehnte. Im Folgenden sollen Besonderheiten der präoperativen Evaluation und Vorbereitung, der Narkoseführung und intraoperativen Überwachung unter Berücksichtigung hämodynamischer Auswirkungen spezieller chirurgischer Techniken (vaskuläre Clampingverfahren), sowie intensivmedizinische Aspekte der postoperativen Therapie beschrieben werden.
Abstract
Hepatectomy has become an established and succesful therapy of malignant and benign liver diseases. Major progress made in the fields of surgery, anaesthesia and intensive care has led to a continuous decrease in perioperative morbidity and mortality despite of extention of indications, degree of invasiveness and increasing age of patients undergoing major liver surgery. In this review, we will report on pecularities of preoperative patient evaluation, anaesthetic management including discussion of hemodynamic side effects of different methods of hepatic vascular occlusion, and summarize liver specific aspects of postoperative intensive care medicine.
Schlüsselworter
Anästhesie - Leber - Resektion - Chirurgie
Key words
Anaesthesia - liver - resection - surgery
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Priv.-Doz. Dr. M. Thiel
Klinik für Anästhesiologie, Klinikum Großhadern
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