原発性副甲状腺機能亢進症に合併した両側尿管嵌頓結石による急性腎不全と肺塞栓の1救命例

A case report of a highly obese woman recovering from acute pulmonary thromboembolism and uremia due to bilateral ureteral impacted stones

　症例は47歳，女性で，高度肥満を有し，両側尿管結石による尿毒症をきたし，血液透析療法施行および腎瘻造設後に急性肺塞栓症（以下，aPE）を併発した。CTにて両肺動脈に塞栓を認め，血栓溶解療法を施行した。発症後3週目のCTでは血栓の消失を認めた。患者は，肥満，長期臥床，中心静脈カテーテル留置などの危険因子を有しており，aPEの予防を目的にヘパリンを早期より積極的に使用すべきであったと考えられた。

　We present a case report of a highly obese 47-year-old woman who had uremia due to bilateral ureteral impacted stones and acute pulmonary thromboembolism（aPE）occurred after hemodialysis and percutaneous nephrostomy formation. The combined therapy with heparin,urokinase and warfarin was started,and aPE disappeared in the CT findings three weeks after the start of therapy. She recovered without any morbidity with appropriate treatments,anticoagulants and transurethral lithotripsy. It is suggested that earlier prophylactic usage of heparin to prevent the emergence of aPE.