Frieser M, Lindner A, Meyer S, Westerteicher M, Hänsler J, Haendl T, Hahn E G, Strobel D, Bernatik T
Medizinische Klinik 1, NOZ, Universität Erlangen-Nürnberg, Ulmenweg 18, Erlangen.
Ultraschall Med. 2009 Apr;30(2):168-74. doi: 10.1055/s-0028-1109314. Epub 2009 Mar 23.
Sonographically guided fine-needle punctures (p.) are considered to be a low risk procedure. Interventions with needles with a larger diameter seem to cause more complications. In search of potential complications, we examined 1923 sonographically guided interventions of the liver and pancreas in a retrospective analysis.
We examined the coherence of the kind of intervention and complications. We considered bleeding with a need for transfusion and/or a need for surgical treatment as complications. Diseases and medication increasing the probability of post-interventional bleeding were also detected.
1923 sonographically guided interventions in the abdomen (1800 in the liver, 123 in the pancreas) were analyzed (n = 1696 diagnostic interventions, n = 227 therapeutic interventions). Needles with diameters > 1 mm were primarily used. Drainage and radiofrequency ablation (RFA) (12 % of all interventions) were performed with devices with diameters between 2 - 3.96 mm. A need for transfusion was found in 8 / 1923 patients (0.4 %), predominantly in the first 24 h. There was no significant correlation between coagulation preventing drugs (heparin, NSAIDs, antiaggregants) and bleeding events. Patients who suffered from liver cirrhosis with a thromboplastin time of < 50 % had a higher risk of post-interventional bleeding than patients with liver cirrhosis and a thromboplastin time > 50 %. Furthermore, therapeutic interventions showed higher complication rates than diagnostic procedures.
Severe bleeding complications with a need for transfusion in sonographically guided procedures are rare (0.4 %). Our results showed that liver cirrhosis with a low thromboplastin time (< 50 %) seems to be the most important risk factor for patients. Overall, sonographically guided interventions are safe and have low complication rates considering careful performance and contraindications.
超声引导下细针穿刺被认为是一种低风险操作。使用较大直径针的干预似乎会导致更多并发症。为了寻找潜在并发症，我们在一项回顾性分析中检查了1923例超声引导下的肝脏和胰腺干预操作。
我们检查了干预类型与并发症之间的相关性。我们将需要输血和/或手术治疗的出血视为并发症。还检测了增加介入后出血可能性的疾病和药物。
分析了1923例超声引导下的腹部干预操作（1800例肝脏操作，123例胰腺操作）（n = 1696例诊断性干预，n = 227例治疗性干预）。主要使用直径> 1 mm的针。引流和射频消融（RFA）（占所有干预的12%）使用直径在2 - 3.96 mm之间的设备进行。1923例患者中有8例（0.4%）需要输血，主要发生在最初24小时内。抗凝药物（肝素、非甾体抗炎药、抗血小板药）与出血事件之间无显著相关性。凝血酶原时间< 50%的肝硬化患者介入后出血风险高于凝血酶原时间> 50%的肝硬化患者。此外，治疗性干预的并发症发生率高于诊断性操作。
超声引导操作中需要输血的严重出血并发症很少见（0.4%）。我们的结果表明，凝血酶原时间低（< 50%）的肝硬化似乎是患者最重要的危险因素。总体而言，考虑到操作仔细和禁忌症，超声引导下的干预是安全的，并发症发生率低。
