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Erschienen in: Der Gastroenterologe 6/2017

15.08.2017 | Operationen an der Leber | Schwerpunkt

Perioperatives Management bei Patienten mit Leberzirrhose

verfasst von: Prof. Dr. J. Rädle, Priv.-Doz. Dr. C. Mönch

Erschienen in: Die Gastroenterologie | Ausgabe 6/2017

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Zusammenfassung

Das Vorliegen einer Leberzirrhose oder finalen Lebererkrankung kann das Morbiditäts- und Mortalitätsrisiko bei elektiven Operationen oder Notfalleingriffen deutlich erhöhen. In Anbetracht der aktuellen medizinischen Möglichkeiten sind die absoluten zugunsten der relativen Kontraindikationen in den Hintergrund getreten. Während Patienten mit einer Zirrhose im Stadium Child-Turcotte-Pugh (CTP) A kein erhöhtes und im Stadium CTP B ein mäßig erhöhtes Operationsrisiko aufweisen, sind elektive Operationen bei Patienten mit einer CTP C-Leberzirrhose oder einem Model-for-End-Stage-Liver-Disease(MELD)-Score >14 aufgrund der beträchtlichen Mortalität in der Regel kontraindiziert. Eine Sonderstellung nimmt die Lebertransplantation bei einem Leberversagen ein. Bei Risikopatienten können durch eine Verbesserung des klinischen Zustands im Vorfeld einer Operation Komplikationen verhindert oder eine Operabilität überhaupt erst ermöglicht werden. Die Eckpunkte dieses Managements basieren besonders auf der perioperativen Therapie von Komplikationen der Leberzirrhose (Koagulopathie, Enzephalopathie, Aszites, Nierenfunktionseinschränkung und Malnutrition). Neben einer präoperativen Identifikation von Risikopatienten durch Scoring-Systeme oder Leberfunktionstests können die perioperativen Risiken auch durch das anästhesiologische Management (Medikamentenauswahl, Vermeiden einer Hypotonie und Volumensteuerung) gesenkt werden. Ferner reduzieren verbesserte chirurgische Operationstechniken, wie minimalinvasive laparoskopische Verfahren und Techniken zur Reduktion des intraoperativen Blutverlusts, ebenso wie eine postoperativ verlängerte intensivmedizinische Überwachung und umfassende Betreuung durch alle beteiligten Fachdisziplinen die perioperative Morbidität und Mortalität.
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Metadaten
Titel
Perioperatives Management bei Patienten mit Leberzirrhose
verfasst von
Prof. Dr. J. Rädle
Priv.-Doz. Dr. C. Mönch
Publikationsdatum
15.08.2017
Verlag
Springer Medizin
Erschienen in
Die Gastroenterologie / Ausgabe 6/2017
Print ISSN: 2731-7420
Elektronische ISSN: 2731-7439
DOI
https://doi.org/10.1007/s11377-017-0192-y

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