Tada K, Komeda H, Yamaha M, Takeuchi T, Kanematsu M, Kuriyama M, Ban Y, Kawada Y
Department of Urology, School of Medicine, Gifu University.
Hinyokika Kiyo. 1987 Nov;33(11):1782-7.
We dissolved the cystine calculi incarcerated in the ureter by irrigation with tromethamine-E via percutaneous nephrostomy. Case 1: A 25-year-old man with a past history of cystinuria and staghorn calculi in the right kidney, suffered from obstructive renal failure caused by the incarceration of a stone (18 x 15 mm) in the left middle ureter. After recovering promptly from renal failure by left percutaneous nephrostomy, he received continuous irrigation with tromethamine-E through an angiographic catheter percutaneously placed in the ureter. The ureteral calculus was reduced by 70% in size after the irrigation for 35 days, and then extracted percutaneously. Case 2: A 3-year-old child had multiple cystine calculi in the right renal pelvis and ureter. Although a calculus in the renal pelvis was extracted by the percutaneous ultrasound lithotripsy, two calculi incarcerated in the middle ureter were impossible to remove by a percutaneous approach. The irrigation with tromethamine-E was initiated through the catheter placed percutaneously in the right ureter. Both calculi completely dissolved 47 days later. The chemolysis by irrigation with tromethamine-E was greatly valuable in the treatment of cystine calculi. This dissolution could be an alternative to surgery especially in the treatment of ureteral cystine calculi, which might be difficult to be extracted by the percutaneous or transurethral approach.
我们通过经皮肾造瘘术用三羟甲基氨基甲烷 - E 冲洗溶解嵌顿在输尿管中的胱氨酸结石。病例 1：一名 25 岁男性，有胱氨酸尿症病史及右肾鹿角形结石，因一枚结石（18×15 毫米）嵌顿于左输尿管中段导致梗阻性肾衰竭。经左经皮肾造瘘术使肾衰竭迅速恢复后，他通过经皮放置在输尿管中的血管造影导管接受三羟甲基氨基甲烷 - E 的持续冲洗。冲洗 35 天后，输尿管结石体积缩小了 70%，随后经皮取出。病例 2：一名 3 岁儿童右肾盂和输尿管有多个胱氨酸结石。尽管通过经皮超声碎石术取出了肾盂中的一枚结石，但两枚嵌顿在输尿管中段的结石无法通过经皮途径取出。通过经皮放置在右输尿管中的导管开始用三羟甲基氨基甲烷 - E 冲洗。47 天后两枚结石完全溶解。用三羟甲基氨基甲烷 - E 冲洗进行化学溶解在胱氨酸结石的治疗中非常有价值。这种溶解可能是手术的一种替代方法，特别是在治疗输尿管胱氨酸结石时，经皮或经尿道途径可能难以取出结石。
