Postoperativer Ileus: Teil I (Experimentelle Therapieansätze)

 

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Zusammenfassung

Postoperative gastrointestinale Motilitätsstörungen haben aufgrund klinischer und ökonomischer Gesichtspunkte eine erhebliche Bedeutung bei der Behandlung von Patienten nach abdominalchirurgischen Eingriffen. In den letzten Jahren hat sich das Verständnis der Pathophysiologie des postoperativen Ileus deutlich erweitert. Die Aktivierung efferenter sympathischer Nervenfasern durch viszerale Afferenzen, Katecholamine und die Stimulation von β₃-Rezeptoren in der Darmwand, eine Entzündungsreaktion in der Darmwand und dabei freigesetztes NO sowie postoperativ zur Analgesie eingesetzte Opioide scheinen hierbei eine zentrale Rolle zu spielen. Die Ausschaltung von afferenten Nervenfasern, nicht-steroidal antiinflammatorische Substanzen, periphere Opioidrezeptor-Antagonisten, Motilide und 5-HT₄-Rezeptoragonisten werden derzeit in experimentellen Studien zum postoperativen Ileus untersucht und stellen in Zukunft eventuell neue Ansätze zur Therapie des postoperativen Ileus dar. Der Artikel fasst den derzeitigen Stand des pathophysiologischen Verständnisses zum postoperativen Ileus und die genannten experimentellen Ansätze zur Therapie zusammen.

Abstract

Postoperative gastro-intestinal motility disorders are of major importance for patient management following abdominal surgery both for clinical and economic reasons. In recent years, new pathophysiological links have been identified that contribute to postoperative ileus. The activation of sympathetic efferent neurons by visceral afferent nerve fibers, catecholamines, the stimulation of β₃-receptors in the gut wall, an inflammatory response of the gut wall with the consecutive release of nitric oxide, and opioids given for postoperative analgesia seem to be of major importance regarding the development of postoperative ileus. The pharmacological reduction of visceral afferent nerve fiber activity, non-steroidal anti-inflammatory drugs (NSAIDs) instead of opioids for postoperative pain, peripheral opioid receptor antagonists together with opioids for postoperative analgesia, motilides and 5-HT₄ receptor agonists as prokinetic drugs are strategies that are currently evaluated to treat postoperative ileus. Our review summarizes the present knowledge on the pathophysiology of postoperative ileus and new experimental treatments that might be of importance in the future.

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Dr. M. E. Kreis

Universität Tübingen · Klinik für Allgemeine Chirurgie

Hoppe-Seyler-Str. 3

72076 Tübingen

Phone: 0 70 71/29-8 11 03

Fax: 0 70 71/29-8 55 00

Email: martin.kreis@uni-tuebingen.de