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Medizintechnik pp 1–37Cite as

Einsatz von Stoßwellen in der Medizin

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Part of the book series: Springer Reference Technik ((SRT))

Zusammenfassung

Im Jahr 1980 wurde der erste Nierensteinpatient mit einer extrakorporalen Stoßwellenlithotripsie (ESWL) minimal invasiv von seinem Steinleiden befreit. Nach den ersten Behandlungen von ca. 200 Patienten konnte 1983 das erste Seriengerät der Öffentlichkeit übergeben werden. Von der ursprünglich auf Nierensteine beschränkten Anwendung wurde das Verfahren auf Steine im gesamten Harntrakt sowie auf andere Gebiete kontinuierlich erweitert. Heute ist die extrakorporale Stoßwellentherapie (ESWT) zur Behandlung von Weichteilschmerzen, bei Plantarfasziitis und Epicondilytis humeri radialis zugelassen. In neuerer Zeit wird der Einsatz von Stoßwellen zur Anwendung biotechnischer Heilmittel mit aussichtsreichen Vorergebnissen erprobt. Auch Patienten mit Angina pectoris profitieren von Druckpulstherapien. Dieses Kapitel gibt einen detaillierten Überblick über die technischen Grundlagen der ESWL und der ESWT sowie die klinische Effizienz von Lithotriptoren inkl. Nebenwirkungen und Sicherheit.

Die Originalversion dieses Kapitels wurde revidiert: Der Herausgebername wurde korrigiert.

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Notes

  1. 1.

    Beschränkungen sind: ein bis maximal drei Steine, Steinmasse entsprechend max. 3 cm3, Motilität der Gallenblase gesichert. Weitere Indikationen sind Gallengangsteine sowie Pankreassteine, insbesondere bei multimorbiden Risikopatienten. Üblich ist eine begleitende Behandlung mit Litholysemedikamenten.

  2. 2.

    Mit speziellen Unterdruckreflektoren wurden schon −50 MPa gemessen.

  3. 3.

    Die Fokusbreite wird auch als FWHM oder auch −6-dB-Breite bezeichnet.

  4. 4.

    Dies ist bei den sphärisch abstrahlenden Funkenquellen der umfasste Raumwinkel.

  5. 5.

    Synthetischer Gips, gemischt mit Glashohlkugeln zur Homogenisierung.

  6. 6.

    Andere Nebenwirkungen der Lithotripsie sind eher biologisch bedingt, z. B. durch Obstruktionen der Harnableitenden Wege.

  7. 7.

    10,9 μs Dauer von P- und 5,5 μs Dauer von P+, bei Variation zwischen 1,6 und 4 MPa (Miller 1995).

  8. 8.

    HM 3 hat klinische Erfolgsraten EQA bis 0,67. Das „Niederdruckgerät“ erreicht einen EQA von bis zu 0,67 gegenüber einem EQA von 0,71 für das „Hochdruckgerät“ (Forssmann et al. 2002; Niersteenverbrijzeling-eng 2005; Lingeman 2008).

  9. 9.

    Die Idee an sich wurde schon vor drei Jahrzehnten umgesetzt, bereits beim „Wasserbad-freien“ Nachfolger des HM 3 war eine Videokamera eingebaut.

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    Friedrich Ueberle

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Ueberle, F. (2015). Einsatz von Stoßwellen in der Medizin. In: Kramme, R. (eds) Medizintechnik. Springer Reference Technik . Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-45538-8_30-1

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