Tsuboi Toshiki, Fujita Tetsuo, Maru Norio, Matsumoto Kazumasa, Iwamura Masatsugu, Baba Shiro
Department of Urology, Kitasato University School of Medicine.
Hinyokika Kiyo. 2008 Jan;54(1):17-22.
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.
特发性血小板减少性紫癜（ITP）是一种自身免疫性疾病，其特征为血小板计数降低，继发于抗血小板抗体导致的血小板加速破坏。由此产生的出血素质可能带来治疗难题。我们治疗了两例ITP患者，在大剂量丙种球蛋白治疗后，分别通过经尿道输尿管镜碎石术（TUL）和体外冲击波碎石术（ESWL）成功取出输尿管结石。第一例患者为一名52岁女性，第二例患者为一名65岁女性。静脉肾盂造影显示，第一例患者左侧输尿管有结石，第二例患者双侧输尿管有结石。大剂量丙种球蛋白治疗和血小板输注将她们的血小板计数提高到了安全水平；随后成功进行了TUL和ESWL，未出现出血并发症。这是首例关于大剂量丙种球蛋白治疗后采用ESWL治疗ITP的病例报告。大剂量丙种球蛋白治疗能有效为ITP患者的手术治疗提供足够的血小板计数。
