Birgin Emrullah, Heil Jan, Walter Benjamin, Wagner Martin, Müssle Benjamin, Kornmann Marko, Seufferlein Thomas, Rahbari Nuh N
Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
Klinik für Innere Medizin 1, Universitätsklinikum Ulm, Ulm, Deutschland.
Chirurgie (Heidelb). 2024 Nov;95(11):887-894. doi: 10.1007/s00104-024-02176-w. Epub 2024 Sep 28.
Severe complications following hepato-pancreato-biliary surgery are frequently due to leakage of anastomoses. Local intraoperative and systematic measures can reduce the incidence of leaks and leak-related sequelae. The early identification of leak-related sequelae, such as hemorrhage is pivotal to reduce the mortality risk. Therefore, perioperative risk stratification incorporating surgical and patient risk factors is crucial. The management of anastomotic leaks is complex and an interdisciplinary treatment is therefore recommended. The treatment depends on the institutional expertise, localization, characteristic features of the anastomosis and the onset of insufficiency. This article describes the different concepts of the diagnostics, prevention, consequences and management of anastomotic leakage in hepato-pancreato-biliary surgery in more detail.
肝胰胆手术后的严重并发症常常归因于吻合口漏。术中局部措施和全身措施可降低吻合口漏及其相关后遗症的发生率。早期识别与漏相关的后遗症，如出血，对于降低死亡风险至关重要。因此，纳入手术和患者风险因素的围手术期风险分层至关重要。吻合口漏的处理较为复杂，因此建议采用多学科治疗。治疗方法取决于机构的专业水平、漏的部位、吻合口的特征以及功能不全的发生时间。本文将更详细地描述肝胰胆手术中吻合口漏的诊断、预防、后果及处理的不同概念。
