论文部分内容阅读
病例摘要例1,25岁,第一胎足月妊娠,上腹痛、恶心、呕吐16小时入院。患者妊娠后期有高血压,发病前一周胎动消失,B 超提示死胎,并发现右肝后叶有一占位病变,诊断肝癌。入院检查:T37℃,P140,R30,Bp140/90。腹膨,上腹压痛,Hb9.8g,GPT88u,ZnTT 正常,AKP9u,SLDH1008u,α-FP(一)。入院后不久娩出一死胎,产后不久疼病波及全腹,Bp80/60,腹腔穿刺为不凝固血,拟诊肝癌破裂。剖腹发现腹腔血液1500ml,右肝外侧膈面有10×10×10cm 大小肿块,中央有7cm 长裂口,子宫纱条压迫止血,术后经过顺利,住院32天痊愈出院。病理报告:肝细胞变性坏死。例2,25岁,第一胎妊娠36~(?2)周,突然上腹痛1小时入院。妊娠30周发现Bp160/100,尿蛋白(+)。体检:T36℃,P124,Bp120/80。Hb9.0g,尿蛋白(++),上腹压痛。入院40分钟胎心消失,破水娩出一死婴。3小时后全身情况恶化,P140,R40,Bp80/50,全腹压痛,移动性浊音(+),腹穿不凝固血,诊断妊娠并发肝破裂。剖腹腹腔血液血块共2200ml,右肝有10×8×6cm 肿块,其中有(?)cm 长裂口,行肝修补和肝动脉结扎,住院18天治愈出院。病理报告:肝组织内有大片出血坏死区。
Case summary 1,25 years old, first-term full-term pregnancy, abdominal pain, nausea, vomiting 16 hours admission. Patients with late pregnancy have high blood pressure, fetal movement disappeared the week before the onset, B-tips of stillbirth, and found that the right posterior lobe has a space-occupying lesion, the diagnosis of liver cancer. Admission examination: T37 ℃, P140, R30, Bp140 / 90. Abdominal swelling, abdominal tenderness, Hb9.8g, GPT88u, ZnTT normal, AKP9u, SLDH1008u, α-FP (a). Shortly after delivery, one stillbirth was delivered. Shortly after delivery, the pain spread to the entire abdomen. Bp80 / 60 and paracentesis were non-coagulated blood, and the liver cancer to be diagnosed was ruptured. Cesarean section found 1500ml of blood in the abdomen, the right side of the diaphragm on the outside of the surface of the size of 10 × 10 × 10cm, 7cm long central cleft, uterine sliver compression hemostasis, postoperative smooth, 32 days hospital discharged. Pathology report: degeneration and necrosis of liver cells. Example 2, 25 years old, the first pregnancy 36 ~ (? 2) weeks, suddenly admitted to the hospital for 1 hour on the abdominal pain. Bp160 / 100, urinary protein (+) was found 30 weeks after pregnancy. Physical examination: T36 ℃, P124, Bp120 / 80. Hb9.0g, urinary protein (++), abdominal tenderness. Fetal heart disappeared 40 minutes after admission, broke the water and delivered a dead baby. 3 hours after the general condition deteriorated, P140, R40, Bp80 / 50, total abdominal tenderness, mobility dullness (+), abdominal percutaneous non-coagulation of blood, diagnosis of pregnancy complicated by liver rupture. Cesarean section blood clots a total of 2200ml, the right liver has 10 × 8 × 6cm mass, which has (?) Cm long gap, liver repair and hepatic artery ligation, hospitalized 18 days cured. Pathology report: Large area of hemorrhage and necrosis in liver tissue.