妊娠合并重型肝炎手术终止妊娠的时机探讨

THE EXPLORATION OF OPERATION OPPORTUNITY TO TERMINATE PREGNANCY FOR HEPATITIS GRAVIS PATIENT IN PREGNANCY

目的探讨妊娠合并重型肝炎手术终止妊娠的时机。方法回顾25例中山大学附属第三医院手术终止妊娠的妊娠合并重型肝炎病例资料,分析终止妊娠原因,根据原因分为被动手术组和主动手术组,对比两组入院时及术前病情、术前凝血功能和术中出血情况以及预后,用Fisher’s精确概率法和t检验进行统计。结果25例患者中仅1例治愈到孕足月终止妊娠,余24例均于入院后1 w内手术终止妊娠,其中14例出现严重并发症或产科原因被迫终止妊娠,10例病情允许纠正凝血功能后手术。两组患者入院时及术前病情无显著性差异,术前被动手术组凝血功能较差,术中出血较多,预后较差。结论妊娠合并重型肝炎终止妊娠时机如下:经治疗病情明显好转可根据产科实际情况选择终止妊娠时机;治疗后病情无好转趋势,改善凝血功能后考虑终止妊娠;病情恶化出现严重并发症如肝性脑病、肝肾综合征、心功能衰竭、肺水肿等,治疗效果不佳时考虑终止妊娠;出现严重产科并发症如胎儿窘迫、胎盘早剥等时考虑终止妊娠;早产临产、临产无法抑制时考虑终止妊娠。

Objective To explore the operation opportunity to terminate pregnancy for hepatitis gravis patients in pregnancy. Methods 25 cases of hepatitis gravis in pregnancy that were performed operation to terminate pregnancy were looked back to. They were divided into voluntary operation group and passive operation group based on the causes of terminating pregnancy. The situation when they were admitted and before operation, coagulation before operation, the amount of bleeding during operation and prognosis between the two groups were compared using t test and Fisher＇ s exact test. Results Only 1 case was cured before terminating pregnancy, the others were performed operation to terminate pregnancy in a week. 14 cases v-ere forced to terminate pregnancy because of the severe complications and the rest 10 cases were performed operation after improving the coagulation. There was no significant difference between the situation of the two groups when they were admitted and before operation. Compared to the voluntary operation group, the patients in the passive group had worse coagulation before operation, more bleeding during operation, and worse prognosis. Conclusion The operation opportunities to terminate pregnancy for hepatitis gravis patient in pregnancy are following： to choose optimal opportu- nity according to obstetric conditions if the situation has been improved greatly ; to terminate pregnancy after improving the coagulation if situation is getting worse gradually; severe complications emerge, such as encephalophathy, hepato - renal syndrome, heart failure and lung edema; severe obstetric complications emerge, such as fetus distresss and abroptio placenta; onset of labor cannot be controlled.