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Prävention und Therapie des postoperativen Leberversagens

Prevention and therapy of postoperative liver failure

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Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Bei Patienten mit vorbestehender Leberzirrhose zeigt sich auch im Rahmen nichthepatobiliär-chirurgischer (N-HPB-)Interventionen ein hohes perioperatives Mortalitäts- und Morbiditätsrisiko infolge eines postoperativen Leberversagens (PLV). Daher sind bei diesem Patientengut, unabhängig von der chirurgischen Fachspezifität, Prävention, Diagnostik und etwaige Therapie des PLV essenziell. Derzeit existiert für N-HPB-Operationen keine einheitliche Definition des PLV. In Analogie zur Definition des PLV durch die International Study Group of Liver Surgery (ISGLS) stellen die progressive Hyperbilirubinämie und Koagulopathie ab dem 5. postoperativen Tag die Kerncharakteristika des PLV dar. Die Child-Turcotte-Pugh-(CTP)-Klassifikation und der Model for End-Stage Liver Disease (MELD) Score sind geeignete Instrumente zur Abschätzung des prospektiven perioperativen Risikos und sollten in die operationsstrategische Planung miteinfließen. Die ISGLS-Klassifikation ist für die postoperative Diagnostik und Behandlung des PLV geeignet. Die Therapie des PLV stellt eine große Herausforderung dar, da derzeit keine kausalen Ansätze existieren und diese lediglich symptomorientiert erfolgt. Daher ist die Prävention des PLV unter Zuhilfenahme eines erfahrenen Hepatologen essenziell.

Abstract

Patients with preexisting cirrhosis who are subjected to hepatobiliary (HBP) or non-hepatobiliary (N-HBP) surgery are expected to bear an exceptionally high risk of morbidity and mortality due to postoperative liver failure (PLV). Therefore, thorough clinical diagnostics, prevention and adequate management of PLV are pivotal for a good outcome irrespective of the type of surgery applied in this particular group of patients. To date there is no standard definition used for PLV. In accordance with International Study Group of Liver Surgery (ISGLS) definition, progressive hyperbilirubinemia and coagulopathy after postoperative day 5 represent the main characteristics implicating PLV. The Child-Turcotte-Pugh (CTP) classification and the model for end-stage liver disease (MELD) score allow a reliable estimation of the perioperative risk and thus provide a useful assistance in planning surgery. The ISGLS classification is helpful in the postoperative diagnosis and treatment of PLV. The treatment of PLV is extremely challenging and limited to counteracting symptoms with no option to cure the underlying liver disease.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. C. Wilms, A. Radtke, S. Beckebaum, V. Cicinatti und H.J. Schmidt geben an, dass kein Interessenkonflikt besteht. Der Beitrag enthält keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik und Poliklinik für Transplantationsmedizin, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A14, 48149, Münster, Deutschland

    C. Wilms, S. Beckebaum, V. Cicinatti & H.J. Schmidt

  2. Klinik für Allgemein- und Viszeralchirurgie, Chirurgisches Zentrum des Reinhard-Nieter-Krankenhauses, Wilhelmshaven, Deutschland

    A. Radtke

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  1. C. Wilms
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  2. A. Radtke
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  3. S. Beckebaum
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  4. V. Cicinatti
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  5. H.J. Schmidt
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Correspondence to C. Wilms.

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Wilms, C., Radtke, A., Beckebaum, S. et al. Prävention und Therapie des postoperativen Leberversagens. Z Herz- Thorax- Gefäßchir 28, 216–221 (2014). https://doi.org/10.1007/s00398-014-1080-0

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  • DOI: https://doi.org/10.1007/s00398-014-1080-0

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