de Calan L, Marboeuf Y, Ozoux J P, Portier G, Chazara C, Body G, Perrotin D, Brizon J
J Gynecol Obstet Biol Reprod (Paris). 1985;14(5):619-22.
The authors report a case of "spontaneous" rupture of the liver in a woman of 35 years of age. This occurred immediately after post-partum eclampsia. It was not possible to obtain complete haemostasis using absorbable haemostatic compresses along the convexity of the liver. Complete cessation of bleeding only occurred after the operation when posterior pituitary abstracts had been transfused. The patient died 53 days after the initial procedure from a high gastro-intestinal haemorrhage. A study of the literature shows that this rare condition is most probably a complication of toxaemia of pregnancy but the physio-pathology of these liver lesions is ill-understood. The clinical picture is in two phases--the first corresponds to the formation of a sub-capsular haematoma and the second to the intra-peritoneal rupture of this haematoma. The prognosis for this condition is poor, the maternal mortality ranging from 56%-75%. The prognosis is linked to the speed with which the diagnosis is made and surgical intervention is carried out. This should be done before the capsule of the liver ruptures. Haemostasis is nearly always best obtained by using haemostatic compression with packs but haemostasis is not always adequate, particularly if there are several lesions in both lobes of the liver. This case history shows that using posterior pituitary abstracts in transfusion can be helpful.
作者报告了一例35岁女性“自发性”肝破裂的病例。该病例发生在产后子痫之后。沿肝脏凸面使用可吸收止血敷布无法实现完全止血。仅在输注垂体后叶提取物后手术时出血才完全停止。患者在初次手术后53天死于严重的胃肠道出血。文献研究表明，这种罕见情况很可能是妊娠中毒症的一种并发症，但这些肝脏病变的生理病理学仍未得到充分了解。临床表现分为两个阶段——第一阶段对应于肝包膜下血肿的形成，第二阶段对应于该血肿的腹腔内破裂。这种情况的预后很差，孕产妇死亡率在56%至75%之间。预后与诊断和手术干预的速度有关。这应在肝脏包膜破裂之前进行。几乎总是通过用敷料进行止血压迫来实现最佳止血，但止血并不总是足够的，特别是如果肝脏两叶都有多处病变。本病例史表明，输血时使用垂体后叶提取物可能会有帮助。
