绒毛膜板下巨大血栓性血肿2例临床病理观察

Massive subchorionic thrombohematoma:a clinicopathologic analysis of two cases

目的探讨绒毛膜板下巨大血栓性血肿(MST)的临床病理特征及预后。方法收集2例MST,进行临床特征、胎盘大体改变及组织学分析,并复习相关文献。结果分析32例MST临床资料特征:分娩时的平均孕周为29.5±4.4周;在妊娠25.4±3.8周左右发现MST;胎儿出生体重平均为947.7±736.7克;胎儿死胎率达40.6%(13/32);终止妊娠率9.4%(3/32);妊娠期间及出生后胎儿有不良反应(生长受限、呼吸抑制、畸形等)率为25%(8/32)。病理学上以绒毛膜板下巨大血栓性血肿为特征,周围胎盘绒毛病变多样,缺乏特异性改变。结论胎盘出现MST会引起高胎儿死亡率及胎儿不良反应率,具有重要临床意义,病理医师需要提高对MST的认识。胎盘病理检查对MST的确诊有重要价值。

Objiective To investigate the clinicopathologic features and prognosis of the massive subchorionic thrombohematoma(MST).Methods We collected two cases of MST.The clincopathologic features were analyed,and 30 relevant literatures were reviewed.Results The clinical data of 32 MST patients were analyzed.The mean gestational age at delivery was 29.5±4.4 weeks.MST was found at about 25.4±3.8 weeks of gestation.The average fetal birth weight was 947.7±736.7 grams.The fetal stillbirth rate was 40.6%(13/32).Pregnancy termination rate was 9.4%(3/32);The incidence of adverse reactions(growth restriction,respiratory depression,deformity,etc.)during pregnancy and after birth was 25%(8/32).Pathologically,it was characterized by a large thrombotic hematoma under the chorionic lamina.The surrounding placental villi were varied and lack of specific changes.Conlusion Placental MST may cause high fetal mortality and fetal adverse reaction rate,which has important clinical significance.Pathologists need to improve their understanding of MST.The pathological examination of placenta is of great value in the diagnosis of MST.