The efficiency of Sairei-to for retroperitoneal fibrosis: two case reports

Abstract

The conventional approach for management of retroperitoneal fibrosis (RF), an inflammatory process of retroperitoneal fibro-adipose tissue, leading to the compression and obstruction of the ureters and other adjacent organs is ureterolysis with omental wrapping, and an effective alternative to surgery is immunosupressive medication such as oral corticosteroids. Sairei-to (TJ-114) is a traditional herbal medicine used for the treatment of RF in Japan. It has both anti-inflammatory and anti-allergic effects. Here we report two cases of RF successfully treated with Sairei-to. One case was idiopathic and the other was caused by artificial graft-induced vasculitis. Both cases were treated with Sairei-to following the decompression of uremia by precutaneous nephrostomy or indwelling ureteral stents. There was hardly any ureteral obstruction three months after the administration of Sairei-to. They have been doing well for 12 and 26 months. Sairei-to rarely causes side effects such as immunodeficiency, gastro-duodenal ulcer and osteoporosis that often accompany long-term administration of corticosteroids. Sairei-to is a safe and effective medicine for the treatment of RF. We therefore recommend Sairei-to as an alternative for corticosteroid therapy.

後腹膜線維症では, 後腹膜における炎症のため線維芽細胞が増殖, 尿管を閉塞させる.以前は尿管剥離術がその治療に行われていたが, 現在はステロイド内服を中心とした保存的方法が主体である.柴苓湯は漢方薬の1つであり, 抗炎症作用と抗アレルギー作用をもつ.そのため後腹膜線維症の治療に柴苓湯は本邦においてしばしば使用される.今回われわれは特発性後腹膜線維症と人工血管による血管周囲炎からくる後腹膜線維症の2例に対し柴苓湯が有効であった症例を報告した.柴苓湯にはステロイドにみられる免疫不全, 胃潰瘍, 骨粗鬆症などの副作用がないため, 後腹膜線維症に対するステロイド内服治療の代替になりうる(著者抄録)