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01.03.2012 | Übersichten

„Small-for-size“

Experimentelle Erkenntnisse für die Leberchirurgie

verfasst von: Dr. rer. nat. C. Eipel, K. Abshagen, B. Vollmar

Erschienen in: Die Chirurgie | Ausgabe 3/2012

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Zusammenfassung

Die Besonderheit der hepatischen Makrozirkulation, d. h. die parallele portalvenöse und arterielle Blutversorgung, ist von erheblicher Relevanz für die Leberchirurgie. Nach ausgedehnter Hepatektomie oder Transplantation einer größenreduzierten Leber wird das verbleibende oder transplantierte Lebergewebe stärker perfundiert, da die Leber den portalvenösen Einstrom kaum regulieren kann. Diese portale Hyperperfusion ist zum einen für die Induktion der Leberzellproliferation verantwortlich, wird auf der anderen Seite aber als einer der wesentlichen Momente in der Pathogenese des „Small-for-size“-Syndroms gesehen. Die sog. „hepatic arterial buffer response“, womit die semireziproke Beziehung zwischen der Durchblutung der Pfortader und der Durchblutung der Leberarterie beschrieben wird, führt gleichzeitig zu einer arteriellen Minderversorgung der „Small-for-size“-Leber. In diesem Beitrag werden experimentelle und klinische Daten diskutiert, die die hohe aber bislang wenig berücksichtigte Relevanz dieser arteriellen Minderversorgung bei der Entwicklung eines „Small-for-size“-Syndroms unterstreichen.
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Metadaten
Titel
„Small-for-size“
Experimentelle Erkenntnisse für die Leberchirurgie
verfasst von
Dr. rer. nat. C. Eipel
K. Abshagen
B. Vollmar
Publikationsdatum
01.03.2012
Verlag
Springer-Verlag
Erschienen in
Die Chirurgie / Ausgabe 3/2012
Print ISSN: 2731-6971
Elektronische ISSN: 2731-698X
DOI
https://doi.org/10.1007/s00104-011-2179-4

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