重度子痫前期伴HELLP综合征合并肝包膜下血肿临床分析

Analysis of severe preeclampsia with HELLP syndrome and hepatic subcapsular hematoma

目的 探讨重度子痫前期伴HELLP综合征合并肝包膜下血肿患者的临床表现与诊疗思路。方法 回顾性分析2014年1月至2023年8月苏州市立医院产科诊治的3例重度子痫前期伴HELLP综合征合并肝包膜下血肿患者,总结其临床特征、治疗经验及预后转归。结果 3例患者中,病例1因重度子痫前期入院,入院B超未见明显异常,剖宫产顺利娩出一女一男,产后伴发部分性HELLP综合征。复查B超、增强CT均提示肝包膜下血肿。因不具备介入、外科治疗指征,以保守治疗为主,随诊至今血肿吸收。病例2于外院术前、术中确诊重度子痫前期合并肝包膜下血肿破裂,持续高热,转入本院,入院检查结果提示伴发完全性HELLP综合征。腹腔引流液培养提示金黄色葡萄球菌感染,积极抗感染等治疗后,病情好转,随诊至今血肿吸收。病例3因阴道流血、流液,突发下腹痛入院,入院即平产一死婴。产后完善相关检查,考虑重度子痫前期伴发完全性HELLP综合征。肾脏受损严重伴腹腔内出血,增强CT提示肝包膜下血肿。保守治疗失败后,即行外科治疗,术后转入ICU积极治疗。目前当地医院继续治疗中,随诊一般情况好。结论 重度子痫前期伴HELLP综合征合并肝包膜下血肿较为罕见,临床表现多样,需密切观察患者一般情况,动态监测血压变化、实验室检查关键指标变化,B超、增强CT对其诊断有较大帮助。治疗方案选择则需结合患者个体情况综合拟定,正确恰当的治疗可有效降低风险,从而改善预后。

Objective To explore the clinical manifestations,diagnosis and treatment of patients with severe preeclampsia with HELLP syndrome and hepatic subcapsular hematoma.Methods Three cases of severe preeclampsia with HELLP syndrome and hepatic subcapsular hematoma diagnosed and treated in the Department of Obstetrics of Suzhou Municipal Hospital from January 2014 to August 2023 were retrospectively analyzed,and the clinical features,treatment experience and prognosis were summarized.Results Among the 3 patients,case 1 was admitted to the hospital due to severe preeclampsia.No obvious abnormality was found in B-ultrasound on admission.One female and one male were successfully delivered by cesarean section,and she was accompanied by partial HELLP syndrome after operation.Repeated B-ultrasound and enhanced CT both suggested hepatic subcapsular hematoma.Because there were no indications for interventional or surgical treatment,conservative treatment was the main treatment,and the hematoma has absorbed since follow-up.Case 2 was diagnosed with severe preeclampsia complicated with hepatic subcapsular hematoma rupture before and during operation in another hospital,and was transferred to our hospital with persistent high fever.The admission examination results suggested that she was accompanied by complete HELLP syndrome.Culture of peritoneal drainage fluid indicated Staphylococcus aureus infection.After active anti-infection treatment,the condition improved,and the hematoma has been absorbed since follow-up.Case 3 was admitted to the hospital with vaginal bleeding and fluid,sudden lower abdominal pain,and delivered a dead baby on admission.Related examinations after surgery were completed,and severe preeclampsia associated with complete HELLP syndrome was diagnosed.Severe renal damage accompanied by intra-abdominal hemorrhage,enhanced CT showed hepatic subcapsular hematoma.After conservative treatment failed,surgical treatment was performed immediately,and the patient was transferred to ICU for active treatment after operation.At present,the local hospital is continuing to treat,and the follow-up is generally good.Conclusions Severe preeclampsia with HELLP syndrome combined with hepatic subcapsular hematoma is rare,and the clinical manifestations are diverse.It is necessary to closely observe the general condition of the patients,dynamically monitor the changes in blood pressure and key laboratory indicators,and B-ultrasound and enhanced CT are helpful for the diagnosis.The choice of treatment plan needs to be comprehensively formulated based on the individual situation of the patient,correct and appropriate treatment can effectively reduce the risk and improve the prognosis.