Damage-control-Konzept bei Leberverletzungen

Rauchfuß, F.; Voigt, R; Götz, M; Heise, Michael; Überrück, T.; Settmacher, Utz

doi:10.1007/s00104-009-1728-6

Cited by 8 publications

(3 citation statements)

References 20 publications

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“…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. Das «Packing» zur temporären Versorgung von Leberverletzungen ist ein fester Bestandteil des Damage-Control-Konzepts [20].…”

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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Section: Leberunclassified

Intensivmedizinische Versorgung nach Abdominaltrauma

2011

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“…За допомогою великої кількості різноманітних досліджень розкриті нові закономірності патологічних змін в залежності від часу, що минув після травми. [29][30][31][32][33][34]. При травмі живота одним з доказових та інформативних методів дослідження є ультразвукова діагностика, за допомогою якої є можливим проведення послідовного та ретельного обстеження внутрішніх органів, зокрема печінки, селезінки, підшлункової залози, нирок, як з метою виявлення наявності та характеру ушкоджень, так і з метою діагностики давності їх виникнення.…”

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Ultrasound Diagnostics of the Nature and Duration of Abdominal Trauma

Babkina¹,

Danylchenko²

2021

Ukr. ž. med. bìol. sportu

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The purpose of the study was to study a complex of changes in ultrasound parameters of injured tissues of the liver, spleen, pancreas in mechanical trauma and their dependence on the nature and duration of injury. Materials and methods. Ultrasound examinations were performed in 60 injured patients (41 males and 19 females) aged 20 to 60 years old in the dynamics as for the 1st, 2nd, 3rd, 4th and 5th days after injury. Puncture, transverse and oblique scans from all possible accesses were used. The conditions of the liver, pancreas, spleen, kidneys were studied. Results and discussion. In the course of the studies, a high number of injuries to the abdominal and retroperitoneal organs was demonstrated; it was proved that isolated liver injuries were observed in 32%, in 68% the liver injury was combined with injuries of other abdominal organs. We observed isolated damage to the pancreas in 10%, in the remaining 90%, the injury to the pancreas was combined with damage to the liver, gallbladder and extrahepatic bile ducts, spleen, and intestines. Isolated injuries of the spleen were observed in 31% of patients; in other cases, the injury to the spleen was combined with injuries of other organs of the abdominal cavity. We observed isolated kidney damage in almost 15%. In 85% of cases, kidney damage was observed in combination with injuries of other parenchymal organs. It has been demonstrated that in the area of injured tissues of the liver, pancreas, spleen, and kidneys with blunt trauma to the abdomen in persons with no signs of alcohol intoxication, regular ultrasound changes are observed, which are in direct proportion to the time elapsed since the injury was caused. The main ultrasound signs of liver damage were ruptures of the parenchyma with the formation of intra-parenchymal or subcapsular hematomas. In general, for almost all the injured people the following sings were characteristic as an increase in liver size (often due to increased part of damage), heterogeneity of structure, blurred contours and their discontinuity, presence of hypo- and anechoic areas (hematomas) on the background of intact parenchyma. Characteristic ultrasound criteria of pancreatic damage in the first day are the lack of clear contours of the gland, their discontinuity, increase in the size of the gland, the presence of hypoechoic areas of different sizes. At ultrasound examination of the spleen, the main signs of its damage are the heterogeneity of the parenchyma and the presence of anechoic structure and free fluid in the abdominal cavity. In 69% of cases, the main sings were blurred and uneven contours of the spleen, as well as an increase in its size. Characteristic features of renal hematoma are an increase in their size, heterogeneity of structure with increasing echogenicity of the parenchyma, blurred contours and their discontinuity. Conclusion. It has been proven that it is advisable to use in a complex of changes in the parenchymal organs revealed by ultrasound examinations, both in cases of isolated organ trauma, and in cases of combined trauma of the abdominal cavity and retroperitoneal organs, to determine the time of causing damage, since it makes it possible to increase the objectivity of the results of establishing the duration of the injury

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“…Das primäre Ziel von Operationen bei traumatischen Leberverletzungen ist das der Blutungskontrolle, das z. B. durch "packing" der Leber erreicht werden kann [54].…”

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Lebertranssektion: moderne Verfahren

Bruns

Büchler

Schemmer

2014

Chirurg

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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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Damage-control-Konzept bei Leberverletzungen

Cited by 8 publications

References 20 publications

Intensivmedizinische Versorgung nach Abdominaltrauma

Intensivmedizinische Versorgung nach Abdominaltrauma

Ultrasound Diagnostics of the Nature and Duration of Abdominal Trauma

Lebertranssektion: moderne Verfahren

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