肝硬化是一种慢性肝病,其中肝组织和血管床被重塑,导致肝功能受损。门静脉高压和随后的食管静脉曲张是肝硬化的常见并发症,并且是肝硬化患者死亡的原因。肝硬化妇女怀孕并不常见,发病率约为5950例怀孕中的1例。肝细胞损伤和性激素代谢的相关改变被认为是负责并导致无排卵。尽管有这些因素,患有肝硬化的妇女可以并且确实怀孕。大多数慢性肝病患者的妊娠是成功的,但是失代偿期肝硬化的母体和胎儿并发症发生率仍然很高。与妊娠相关的门静脉高压是一种高风险情况,因为妊娠和门静脉高压都有一些血液动力学变化。妊娠期间静脉曲张出血和肝功能失代偿的风险增加很多倍。尽管上面提到了可能的并发症,目前肝病学的发展降低了母胎发病率和死亡率,用药物和/或内镜下静脉曲张结扎术预防静脉曲张出血,改善肝移植,以及在这些问题上的更多经验。我们介绍了一例31岁的肝硬化女性患者,该患者在插入经颈静脉肝内门体分流术(TIPS)后成功完成了妊娠和分娩,没有并发症。不幸的是,交货后2年,患者发展成淋巴母细胞淋巴瘤,尽管对这种疾病进行了强化治疗,病人在40岁时去世。我们没有发现肝硬化和淋巴母细胞淋巴瘤之间的任何联系。
Liver cirrhosis is a chronic liver disease in which the liver tissue and the vascular beds are remodeled leading to impaired hepatic function. Portal hypertension and subsequent esophageal varices are a frequent complication of liver cirrhosis and are a cause of mortality in patients with liver cirrhosis. Pregnancy in women with liver cirrhosis is uncommon, the incidence being about 1 in 5 950 pregnancies. Hepatocellular damage and the associated alteration in the metabolism of the sex hormones is thought to be responsible and leads to anovulation. In spite of all these factors, women with cirrhosis can and do become pregnant. Pregnancy is successful in most of the patients with chronic liver disease, but maternal and fetal complication rates are still high for decompensated liver cirrhosis. Portal hypertension associated with pregnancy is a high-risk situation as both pregnancy and portal hypertension share some of the hemodynamic changes. Risks of variceal bleeding and hepatic decompensation increases many fold during pregnancy. Despite the possible complications mentioned above, the maternal-fetal morbidity and mortality rates have been decreased by the current developments in hepatology, prevention of bleeding from varices with drugs and/or endoscopic variceal ligation, improvement in liver transplantation, and an increased experience in these issues. We present a case of a 31-year-old female patient with liver cirrhosis who successfully managed pregnancy and birth without complications after the insertion of transjugular intrahepatic portosystemic shunt (TIPS). Unfortunately, 2 years after delivery, the patient developed lymphoblastic lymphoma and, despite intensive therapy for this disease, the patient died at the age of 40. We did not find any link between liver cirrhosis and lymphoblastic lymphoma.