Benes J, Stuka C, Maresová J, Danzig V, Bicík V
Interní klinika 1. LF UK a VFN, Praha.
Cas Lek Cesk. 1998 Sep 21;137(18):565-6.
Extracorporeal shock wave lithotripsy is relatively contraindicated in patients with an implanted cardiac pacemaker. Shock waves can damage the pacemaker by mechanical pressure and also by electromagnetic induction. Since the distance between the applicator and the pacemaker is small during biliary lithotripsy, the risk of damaging the pacemaker is greater. In the following case, the patient presented with a stone in the common bile duct, and had an implanted pacemaker. Lithotripsy with non-synchronized shock waves was the method of choice since conventional surgery was high risk in this specific case.
In an 84-year-old woman with a stone in the proximal part of the common bile duct, endoscopic attempts of extraction failed. Therefore, shock wave lithotripsy was indicated. This patient had serious heart disease with an interference of spontaneous heart action with the pacemaker at a ratio of 1:1. We decided to treat with shock wave lithotripsy. The application of shock waves was without side effects on the patient and the pacemaker.
This case is interesting as it highlights the possibility of using the Czech made MEDILIT lithotriptor in the treatment of choledocholitiasis in patients with a pacemaker. Even so, it is necessary to monitor the patient's ECG to ensure the possibility of immediate external stimulation.
体外冲击波碎石术对于植入心脏起搏器的患者相对禁忌。冲击波可通过机械压力以及电磁感应损坏起搏器。由于在胆管碎石术期间，探头与起搏器之间的距离较小，损坏起搏器的风险更大。在以下病例中，患者患有胆总管结石且植入了起搏器。由于在该特定病例中传统手术风险较高，因此选择非同步冲击波碎石术。
一名84岁女性，胆总管近端有结石，内镜下取石尝试失败。因此，需要进行冲击波碎石术。该患者患有严重心脏病，起搏器对自发心脏活动的干扰比例为1:1。我们决定采用冲击波碎石术进行治疗。冲击波的应用对患者和起搏器均无副作用。
该病例很有意思，因为它凸显了使用捷克制造的MEDILIT碎石机治疗起搏器患者胆总管结石的可能性。即便如此，有必要监测患者的心电图，以确保能够进行即时外部刺激。
