Transurethral ureterolithotripsy and extracorporeal shock wave lithotripsy in patients with idiopathic thrombocytopenic purpura

Abstract

特発性血小板減少性紫斑病(ITP)は, 抗血小板抗体により血小板減少を来たす自己免疫性疾患である。血小板減少による出血性素因は, 各種治療を困難にする。今回われわれは, 本疾患2症例に対し, ガンマグロブリン大量療法を行った後, 経尿道的尿管砕石術(TUL)および体外衝撃波砕石術(ESWL)が施行可能であったので報告する。症例1は52歳, 女性, 症例2は65歳, 女性, 静脈性腎盂造影にて左尿管結石症および両側尿管結石症と診断された。ガンマグロブリン大量療法と血小板輸血により血小板数は増加し, TULおよびESWLを合併症なく施行可能であった。ITPに対するガンマグロブリン大量療法後のESWL施行例は, 本報告が初めてである。ガンマグロブリン大量療法は, ITP症例において外科的治療を施行するにあたり, 十分な血小板数を得られる有効な方法であると考えられた。(著者抄録)

Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disease defined by a low platelet count secondary to accelerated platelet destruction by anti-platelet antibodies. The resulting bleeding diathesis can present a therapeutic dilemma. We have treated two cases of ITP in which ureteral stones were successfully extracted by transurethral ureterolithotripsy (TUL) and extracorporeal shock wave lithotripsy (ESWL) after high-dose gamma-globulin therapy. The first case was in a 52-year-old woman and the second case was in a 65-year-old woman. Intravenous pyelography revealed a left ureteral stone in the first case and bilateral ureteral stones in the second case. High-dose gamma-globulin therapy and platelet transfusion elevated their platelet counts to safe levels; TUL and ESWL were then performed successfully with no bleeding complications. This is the first case report of ITP being treated by ESWL after high-dose gamma-globulin therapy. High-dose gamma-globulin therapy effectively provides adequate platelet counts for surgical treatment in patients with ITP.