妊娠合并自发性肝破裂的临床研究(附1例报道)

Clinical Research on Spontaneous Rupture of the Liver During Pregnancy

目的探讨妊娠合并自发性肝脏破裂临床表现的特点,指导临床诊断与治疗。方法报道1例并复习23例文献报告病例,总结其发病时间、临床表现、治疗方法及预后,发现其中的规律。结果总计24例患者,14例合并有子痫或先兆子痫,死亡12例。发病与产次及是否初产妇无明显相关性,临床表现均有上腹疼痛或剑突下疼痛。B超是最好的诊断方法。破裂多见于右肝膈面,止血方法多样,术后有可能出现DIC及多器官功能衰竭。结论妊娠合并自发性肝脏破裂死亡率高,应重视其早期诊断与治疗,并注重术后康复治疗,以提高孕产妇及围产儿存活率。

Objective To investigate the spontaneous rupture of the liver during pregnancy, in order to guide the diagnose and treatment. Methods To analyze 1 case in our hospital and 23 cases from literature reports, summarize their clinical situation, treatments and prognosis and find the regularity. Results In all 24 cases, 12 patients died, 14 cases had eclampsia or preeclampisa. There was no obviously correlation between morbility and parity. All patients had aches from superior belly or appendix ensiformis. Ultrasound was the best diagnostic method. Ruplure of liver often took place in right facies diaphragmatica hepatic. There were many kinds of hemostasis. Disseminated intravascular coagulation and facies diaphmgmatica hepatic probably happened after operation. Conclusion Because of the high mortality, the early diagnosis and treatment are very important, rehabilitative treatment after operation should be attendoned. These could help us to increase the survival rate of pregnant women and perinatal period children.