Sonografisch gestützte Interventionen
(auch eine kleine Materialkunde)

 

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Zusammenfassung

Ultraschall-gezielte Punktionen und Drainagetechniken gehören seit vielen Jahren zum routinemäßigen Klinikalltag. Zunehmend werden interventionelle Eingriffe geplanten chirurgischen Operationen vorangestellt, da durch diese Kombination eine Risikoreduzierung erreichbar ist. Inzwischen ist das Angebot an Punktionsnadeln und Drainagen sehr groß geworden, sodass für jede Indikation, teilweise organabhängig, spezielles Zubehör angeboten wird. Diese Materialkunde soll einen Überblick über die vorhandenen Möglichkeiten bringen und bei der ersten Auswahl behilflich sein. Entscheidend für den Erfolg sind jedoch die persönliche Erfahrung mit der spezifischen Untersuchungsmethode und die Kenntnis des Umgangs mit dem technischen Material. Erfahrene interventionelle Ultraschalluntersucher benutzen daher meist ein ausgewähltes Angebot an Punktionsnadeln und Drainagezubehör, welches ihnen jedoch intensiv vertraut ist. Auf spezielle Indikationen wird kurz eingegangen.

Abstract

For many years ultrasound-guided biopsy and drainage has represented a routine part of clinical practice. Percutaneous biopsy and drainage are minimally invasive procedures for sampling tissue or the removal of fluid collections within the body. Differing image guidance techniques for the positioning of the needles/catheters are in use. This is due to the advancement of effectiveness and safety of modern guidance methods. For the management of abscesses, percutaneous drainage is more effective (depending on the size) than percuataneous needle aspiration and is being increasingly used as the first-line treatment. This shift in practice is driven by the preference for low-risk, minimally invasive procedures and thus using surgical interventions only when percutaneous drainage has been unsuccessful. However, the variety of biopsy needles and drainage systems available to the clinician can appear overwhelming. We present a literature review regarding the devices and materials currently available to achieve the most reliable results with the lowest level of complications. With regard to drainage systems, particular considerations include the consistency of fluid, path of access and guidance technique. Although we present comparisons between published studies, it is important to consider that the personal experience of the interventionalist will also have an impact on the device chosen.

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Prof. Dr. Christoph F. Dietrich

Medizinische Klinik 2, Caritas-Krankenhaus Bad Mergentheim

Uhlandstr. 7

97980 Bad Mergentheim

Phone: ++ 49/79 31/58 22 01

Fax: ++ 49/79 31/58 22 90

Email: christoph.dietrich@ckbm.de