Hunter S K, Martin M, Benda J A, Zlatnik F J
Department of Obstetrics and Gynecology, University of Iowa College of Medicine, Iowa City, USA.
Obstet Gynecol. 1995 May;85(5 Pt 2):819-22. doi: 10.1016/0029-7844(94)00348-h.
Spontaneous hepatic rupture associated with preeclampsia is a rare but life-threatening situation. Several different surgical treatments have been described, depending on the severity of the rupture. Liver transplantation has become the mainstay for patients with end-stage liver disease. Transplantation in the setting of liver trauma or massive parenchymal disruption is not well defined. To our knowledge, this treatment has not been reported for spontaneous hepatic rupture in pregnancy.
Massive, spontaneous hepatic rupture occurred in a patient at 36 weeks' gestation as a result of severe preeclampsia. Conventional surgical therapies were unsuccessful in controlling the massive hemorrhage. As a life-saving measure, the patient underwent total hepatectomy with the creation of an end-to-side portcaval shunt, thereby rendering the patient anhepatic. The patient was listed as urgently needing a liver for transplantation through the United Network for Organ Sharing. A suitable donor liver was located approximately 8 hours after the emergency hepatectomy. The patient underwent orthotopic liver transplantation after being maintained in an anhepatic state for almost 13 hours. The patient was discharged on postoperative day 41, suffering only from some ischemic lower extremity neuropathy secondary to hypovolemic hypotension occurring during the hepatectomy procedure.
In the reported case, spontaneous hepatic rupture resulted in a massive hemorrhage that could not be controlled by previously reported techniques and required total hepatectomy followed by liver transplantation.
子痫前期相关的自发性肝破裂是一种罕见但危及生命的情况。根据破裂的严重程度，已有几种不同的手术治疗方法被描述。肝移植已成为终末期肝病患者的主要治疗手段。肝外伤或大量实质破坏情况下的移植尚未明确界定。据我们所知，这种治疗方法尚未见用于妊娠自发性肝破裂的报道。
一名36周妊娠的患者因重度子痫前期发生大量自发性肝破裂。传统手术治疗未能控制大量出血。作为一种挽救生命的措施，患者接受了全肝切除术并建立了端侧门腔分流术，从而使患者处于无肝状态。通过器官共享联合网络，该患者被列为急需肝移植。在急诊肝切除术后约8小时找到了合适的供肝。患者在无肝状态下维持近13小时后接受了原位肝移植。患者于术后第41天出院，仅患有肝切除术中因低血容量性低血压继发的一些缺血性下肢神经病变。
在本报道病例中，自发性肝破裂导致大量出血，先前报道的技术无法控制，需要全肝切除术后进行肝移植。
