Chirurgische Therapie des Lebertraumas

Bruns, Helge; Frankenberg, Moritz von; Radeleff, Boris; Schultze, Daniel; Büchler, M.; Schemmer, Peter

doi:10.1007/s00104-009-1729-5

Cited by 15 publications

(3 citation statements)

References 71 publications

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“…Liver resections are rarely required in the initial surgical treatment of liver trauma. Anatomical liver resections, which may be necessary in individual cases, should be performed by experienced liver surgeons to achieve acceptable outcome [ 35 – 37 ].…”

Section: Discussionmentioning

confidence: 99%

Use of angioembolization, treatment modalities and mortality in association with blunt liver trauma in Germany — a data analysis of the TraumaRegister DGU®

Beltzer,

Imach,

Wafaisade

et al. 2023

Langenbecks Arch Surg

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Purpose Angioembolization (ANGIO) is highly valued in national and international guideline recommendations as a treatment adjunct with blunt liver trauma (BLT). The literature on BLT shows that treatment, regardless of the severity of liver injury, can be accomplished with a high success rate using nonoperative management (NOM). An indication for surgical therapy (SURG) is only seen in hemodynamically instable patients. For Germany, it is unclear how frequently NOM $$\pm$$ ± ANGIO is actually used, and what mortality is associated with BLT. Methods A retrospective systematic data analysis of patients with BLT from the TraumaRegister DGU® was performed. All patients with liver injury AIS ≥ 2 between 2015 and 2020 were included. The focus was to evaluate the use ANGIO as well as treatment selection (NOM vs. SURG) and mortality in relation to liver injury severity. Furthermore, independent risk factors influencing mortality were identified, using multivariate logistic regression. Results A total of 2353 patients with BLT were included in the analysis. ANGIO was used in 18 cases (0.8%). NOM was performed in 70.9% of all cases, but mainly in less severe liver trauma (AIS ≤ 2, abbreviated injury scale). Liver injuries AIS ≥ 3 were predominantly treated surgically (64.6%). Overall mortality associated with BLT was 16%. Severity of liver injury ≥ AIS 3, age > 60 years, hemodynamic instability (INSTBL), and mass transfusion (≥ 10 packed red blood cells/pRBC) were identified as independent risk factors contributing to mortality in BLT. Conclusion ANGIO is rarely used in BLT, contrary to national and international guideline recommendations. In Germany, liver injuries AIS ≥ 3 are still predominantly treated surgically. BLT is associated with considerable mortality, depending on the presence of specific contributing risk factors.

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Section: Discussionmentioning

confidence: 99%

Use of angioembolization, treatment modalities and mortality in association with blunt liver trauma in Germany — a data analysis of the TraumaRegister DGU®

Beltzer,

Imach,

Wafaisade

et al. 2023

Langenbecks Arch Surg

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“…Sollte nach einem Abdominaltrauma mit Verletzung der Leber ein chirurgisches Vorgehen notwendig sein, ist eine anatomische Leberresektion allenfalls bei kompletten Gefäßausrissen indiziert [19]. Durch eine 4-Quadranten-Tamponade, gegebenenfalls nach dem Pringle-Manöver durch das Abklemmen des Ligamentum hepatoduodenale, kann die Blutung aus dem Leberparenchym vorerst kontrolliert und das Abdomen nach weiteren Verletzungen abgesucht werden.…”

Section: Leberunclassified

Intensivmedizinische Versorgung nach Abdominaltrauma

2011

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Nach präklinischer Versorgung, Schockraumdiagnostik und/oder operativem Eingriff werden schwerverletzte Patienten auf der Intensivstation weiterbehandelt. Hypothermie, Azidose und Koagulopathie sowie im späteren Verlauf Systemisches inflammatorisches Response-Syndrom (SIRS) und septische Komplikationen bestimmen hier unmittelbar die Therapieschritte. In der Behandlung abdomineller Verletzungen findet ein Paradigmenwechsel in Richtung organerhaltender und nicht operativer Therapiekonzepte statt. Das Ziel besteht darin, die kritische Belastung durch das Trauma und eine Operation zu minimieren (Damage Control Surgery). Im weiteren Verlauf gehören neben der Sonographie klinische Untersuchungen des Abdomens (Abwehrspannung, Peristaltik), Bestimmung der Laborparameter im Serum (Retentionswerte, Leberenzyme, Entzündungswerte, Laktat, Creatinin-Kinase), Monitoring der Drainagenflüssigkeit (Redons, Robinson-Drainagen) und Messung des intraabdominellen Drucks zu den wichtigsten Überwachungsparametern bei den verletzten Patienten. Durch die engmaschige Verlaufsbeobachtung können übersehene Verletzungen und Komplikationen frühzeitig diagnostiziert und behandelt werden.

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“…5% primäre Lebermalignome -hiervon etwa die Hälfte hepatozelluläre Karzinome -und der allergrößte Teil sekundäre Malignome, von denen die meisten Metastasen kolorektaler Karzinome sind [6,8,32]. Das Management der traumatischen Leberverletzungen erfolgt inzwischen überwie-gend konservativ und nur bei fortbestehenden aktiven Blutungen und hämody-namischer Instabilität ist eine notfallmä-ßige Operation indiziert, bei der allenfalls ein vorsichtiges Débridement erfolgen sollte; anatomische Leberresektionen sind nur bei kompletten Gefäßausrissen indiziert [9]. Das primäre Ziel von Operationen bei traumatischen Leberverletzungen ist das der Blutungskontrolle, das z.…”

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Lebertranssektion: moderne Verfahren

Bruns

Büchler

Schemmer

2014

Chirurg

Self Cite

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Liver resection has developed into the current standard procedure due to modern resection techniques, profound knowledge of the liver anatomy and optimized surgical and anesthesiological strategies to allow extended resections with both low morbidity and mortality. Initially major blood loss was the biggest concern with liver resection and a Pringle's manoeuvre was necessary. Nowadays, biliary leakage is the major problem after liver surgery. Besides the classical conventional clamp crushing technique for parenchymal transection, various devices including ultrasound, microwaves and staplers have been introduced. Minimally invasive techniques have become increasingly important for liver resection but are still applied in selected patients only. The selection of the resection technique and device mainly depends on the extent of the resection and also on the liver parenchyma, the liver disease, costs, personal experiences and preferences. This article presents a selection of techniques used in modern parenchymal transection during liver resection with special focus on transection time, blood loss, bile leakage and costs.

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Chirurgische Therapie des Lebertraumas

Cited by 15 publications

References 71 publications

Use of angioembolization, treatment modalities and mortality in association with blunt liver trauma in Germany — a data analysis of the TraumaRegister DGU®

Use of angioembolization, treatment modalities and mortality in association with blunt liver trauma in Germany — a data analysis of the TraumaRegister DGU®

Intensivmedizinische Versorgung nach Abdominaltrauma

Lebertranssektion: moderne Verfahren

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