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Lebertrauma

Interventionelle und konservative Therapie

Hepatic trauma

Interventional and conservative therapy

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Zusammenfassung

Bei hämodynamisch stabilen Patienten mit Lebertrauma stellt das nichtoperative Management derzeitig die Standardtherapie dar. Die Erfolgsrate dieser Behandlungsform beträgt über 80%. Bei hämodynamischer Instabilität oder höhergradigen Leberverletzungen ist in den meisten Fällen jedoch eine chirurgisch-operative Intervention erforderlich. Bei der nichtoperativen Therapie von Leberverletzungen steht die intensivmedizinische Überwachung der Patienten im Vordergrund. Wiederholt durchgeführte bildgebende Untersuchungen im Verlauf sind lediglich bei höhergradigen Verletzungen und im Fall von Komplikationen erforderlich. Zur Vermeidung von Operationen kommen zur Behandlung von Gallenwegskomplikationen die endoskopisch-retrograde Cholangiopankreotikographie und bei Gefäßkomplikationen radiologisch-interventionelle Verfahren wie die Angiographie zunehmend zum Einsatz. Die Erfolgsraten der nichtoperativen Therapie konnte insgesamt so über die letzten Jahrzehnte kontinuierlich verbessert werden.

Abstract

The non-operative management of hemodynamically stable patients with liver trauma has become the standard of care. Non-operative treatment has a success rate of >80%. In the majority of cases of hemodynamic instability or high grade liver injuries, however, a surgical approach is necessary. As for conservative treatment of liver trauma the surveillance of patients in the ICU is of utmost importance. Repeat CT scans are only necessary in patients with high grade injuries or in case of complications. Interventional procedures, such as the endoscopic retrograde cholangiopancreatography in cases of biliary complications or angiography for vascular complications, are increasingly being used in order to avoid surgery. The success rates of non-operative strategies have been improving continuously over the last decades.

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Authors and Affiliations

  1. Klinik und Poliklinik für Chirurgie, Universitätsklinikum, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland

    M. Loss & H.J. Schlitt

  2. Institut für Röntgendiagnostik, Universitätsklinikum, Regensburg, Deutschland

    N. Zorger

  3. Klinik und Poliklinik für Innere Medizin I, Universitätsklinikum, Regensburg, Deutschland

    G.I. Kirchner

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  1. M. Loss
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  2. N. Zorger
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  3. G.I. Kirchner
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  4. H.J. Schlitt
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Correspondence to M. Loss.

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Loss, M., Zorger, N., Kirchner, G. et al. Lebertrauma. Chirurg 80, 908–914 (2009). https://doi.org/10.1007/s00104-009-1727-7

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