Mahmoud Ali, Manka Madeleine, Lipworth Roy, Heslop Daniel, Sharma Vidit, Husmann Douglas, Westerman Mary E
School of Medicine, University of Texas Medical Branch, Galveston, Texas.
Department of Urology, Mayo Clinic Minnesota, Rochester, Minnesota.
J Endourol Case Rep. 2019 Mar 16;5(1):16-18. doi: 10.1089/cren.2018.0088. eCollection 2019.
We report the first case of instillation of alteplase, a tissue plasminogen activator, to dissolve occlusive upper urinary tract blood clot. A 67-year-old Caucasian man with a solitary kidney became dialysis dependent because of upper urinary tract clot obstruction after ureteral stent placement for obstructing ureterolithiasis. After failure of more conservative measures, 10 mg of alteplase was instilled through nephrostomy tube daily for 2 consecutive days 30 minutes before manual irrigation with physiologic saline. After alteplase instillation, the occlusive blood clot dissolved with rapid improvement in urinary output and creatinine. Alteplase instillation through nephrostomy tube is a viable option to dissolve obstructing upper urinary tract blood clots.
我们报告了首例使用组织型纤溶酶原激活剂阿替普酶灌注溶解上尿路闭塞性血凝块的病例。一名67岁的白人男性，因输尿管结石梗阻行输尿管支架置入术后，上尿路血凝块阻塞导致单肾依赖透析。在更保守的措施失败后，在每天用生理盐水手动冲洗前30分钟，通过肾造瘘管连续2天每日灌注10毫克阿替普酶。阿替普酶灌注后，闭塞性血凝块溶解，尿量和肌酐迅速改善。通过肾造瘘管灌注阿替普酶是溶解阻塞性上尿路血凝块的可行选择。
