Britton R C
Am J Surg. 1982 Apr;143(4):421-5. doi: 10.1016/0002-9610(82)90190-8.
A review of the case histories of 53 patients with established cirrhosis who had 83 pregnancies and 38 noncirrhotic patients with varices who had 77 pregnancies suggests that conception may occur in patients with varying degrees of hepatic decompensation, that sustaining gestation to term and delivery is unlikely to overtax cirrhotic livers in patients who are able to conceive, that infertility does not necessarily follow portal decompression operations, that fatal hemorrhage from preexisting esophageal varices is not more likely to occur during gestation, that variceal hemorrhage during pregnancy is not predictable on the basis of individual history of bleeding, and that the risk of variceal bleeding is not increased during vaginal delivery. Management of the rare patient with the combination of inactive cirrhosis, portal hypertension and esophageal varices requires a high degree of individualization. The strong desire for a child must be balanced against acceptance of an indeterminate prognosis of intrinsic liver disease, the possible need to terminate pregnancy in the presence of progressive hepatic decompensation, and termination of pregnancy when the potential for fetal abnormality resulting from serious hemorrhage early in gestation is significant. Under these circumstances and with currently available methods for the control of active variceal bleeding, a nihilistic approach cannot be justified.
对53例确诊肝硬化患者的83次妊娠病例史以及38例有静脉曲张的非肝硬化患者的77次妊娠病例史进行回顾分析，结果表明：不同程度肝失代偿的患者可能受孕；能够受孕的肝硬化患者维持妊娠至足月分娩不太可能使肝脏负担过重；门静脉减压手术后不一定会导致不孕；妊娠期间，原有食管静脉曲张导致致命出血的可能性并不更高；无法根据个体出血史预测妊娠期静脉曲张出血；阴道分娩期间静脉曲张出血风险不会增加。对患有静止性肝硬化、门静脉高压和食管静脉曲张的罕见患者进行管理需要高度个体化。想要孩子的强烈愿望必须与接受肝脏疾病固有不确定预后、在出现进行性肝失代偿时可能需要终止妊娠以及在妊娠早期严重出血导致胎儿异常可能性很大时终止妊娠相权衡。在这种情况下，以及采用目前可用的控制活动性静脉曲张出血的方法，虚无主义的方法是不合理的。
