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Viszeralchirurgie 2004; 39(6): 473-482
DOI: 10.1055/s-2004-832402
Originalarbeit

© Georg Thieme Verlag Stuttgart · New York

Funktionelle Lebermorphologie und anatomiegerechte Prinzipien der Leberchirurgie

Functional Liver Morphology and Anatomical Principles of Liver SurgeryD. C. Bröring1 , X. Rogiers1
  • 1Klinik für Hepatobiliäre Chirurgie und Viszerale Transplantation
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Publication History

Publication Date:
01 December 2004 (online)

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Zusammenfassung

Die Leberchirurgie hat sich in den letzten Jahren zu einer standardisierten und sicheren Operation innerhalb der Viszeralchirurgie entwickelt. Die Mortalität liegt in erfahrenen Zentren heute unter 5 %, die Morbidität unter 30 %. Die Kenntnisse der intrahepatischen Anatomie und technischen Fähigkeiten des Chirurgen sind die maßgeblichen Faktoren, die diese Ergebnisse ermöglichen. Die postoperative Leberinsuffizienz ist die häufigste Ursache komplizierter Verläufe nach Leberteilresektion. Daher kommt der Bestimmung des prospektiven Leberrestvolumens und der -funktion eine besondere Bedeutung zu. Während das Restlebervolumen heute mittels CT oder MRT leicht bestimmt werden kann, basiert die Einschätzung der prospektiven Restleberfunktion in Ermangelung aussagefähiger Funktionstests noch heute auf die Erfahrung des Chirurgen. Bei normaler Leberqualität sollte das prospektive Leberrestvolumen mehr als 0,5 % des Körpergewichtes betragen. Mit einer Unterschreitung dieser unteren Grenze ist nur bei der erweiterten Hemihepatektomie rechts zu rechnen. Wird diese Grenze unterschritten, kann durch eine Pfortaderligatur, oder -embolisation der zu resezierenden Lebersegmente das prospektive Leberrestvolumen vergrößert werden. Bei eingeschränkter Leberqualität (Leberfibrose, -zirrhose, Fettleber, Cholestase, Z. n. Chemotherapie) können diese Methoden ebenfalls zur Verbesserung der postoperativen Leberfunktion beitragen. Die Anwendung in dieser Situation bedarf jedoch einer besonderen Erfahrung und Sorgfalt.

Abstract

Liver surgery has developed to a standardized and safe procedure within abdominal surgery. In experienced centres postoperative mortality reached nowadays less than 5 % and morbidity less than 30 %. Knowledge of the intrahepatic anatomy and technical skills are the main factors, which contribute to these results. Postoperative liver insufficiency is the most common reason for significant postoperative disturbance. Therefore measurement of volume and function of the future liver remnant is an important issue. The volume of the future liver remnant can be easily calculated with CT or MRI. Estimation of the function of the future liver remnant is still based on the experience of the surgeon, since available liver function tests are failing to predict function of the future liver remnant. In cases of normal liver quality the volume of the future liver remnant should be larger than 0.5 % of body weight. This limit will be reached only by performing extended right resections. Both, portal vein ligation and embolisation are able to increase the remnant liver volume prior resection. These tools are also helpful in patients with impaired liver quality due to fibrosis, cirrhosis, fatty change, cholestasis, or status post chemotherapy. The indication in this situation is based on individual situations and needs special experience and carefulness.

Schlüsselwörter

Leberchirurgie - Anatomie - Leberresektion - Funktionsreserve - Leberregeneration - Pfortaderembolisation

Key words

Liver surgery - anatomy - hepatic resection - functional reserve - liver regeneration - portal vein embolisation

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Prof. Dr. med. Dr. h. c. Xavier Rogiers

Universitätsklinikum Hamburg Eppendorf · Klinik für Hepatobiliäre Chirurgie und Viszerale Transplantation

Martinistraße 52

20246 Hamburg

Phone: + 49/40/4 28 03-61 36

Fax: + 49/40/4 28 03-34 31

Email: rogiers@uke.uni-hamburg.de

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