Первичная брюшная беременность в печени (клиническое наблюдение и обзор литературы)

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Мы представляем случай беременной пациентки (уровень β-ХГЧ 740 мЕд/мл), поступившей в хирургическое отделение с жалобами на боли в правом подреберье и подозрением на острый холецистит. При ультразвуковом исследовании (УЗИ) обнаружено наличие свободной жидкости в брюшной полости. Для исключения эктопической беременности проведена лапароскопия, при которой обнаружено кровотечение из правого яичника и гемоперитонеум (100 мл). Кровотечение остановлено путем коагуляции. Предположено, что беременность маточная, но через 2 дня в связи с отсутствием нормального роста уровня β-ХГЧ выполнено ее инструментальное удаление. Еще через 4 дня при незначительном росте уровня β-ХГЧ (до 820 мЕд/мл), появлении у больной анемии легкой степени и наличии ультразвуковых признаков свободной жидкости в брюшной полости проведена вторая диагностическая лапароскопия, при которой патологии органов брюшной полости, кроме гемоперитонеума (50 мл), не найдено. Удалены остатки плодного яйца из полости матки. Однако последующее плато уровня β-ХГч, обнаружение при выполнении УЗИ и мультиспиральной компьютерной томографии образования в печени и патоморфологическое заключение об отсутствии хориона в соскобах из полости матки указывали на возможное наличие печеночной беременности (ПБ). При третьей лапароскопии диагноз подтвержден и ПБ удалена. После операции у пациентки были три неосложненные доношенные беременности, завершившиеся родами. Обсуждение наблюдения дополнено обзором 76 случаев ПБ беременности, описания которых найдены нами в мировой литературе.

Ключевые слова:

беременность печеночная

беременность эктопическая

диагноз дифференциальный

хорионический гонадотропин человека

бета-субъединица

хирургическое лечение

эндоскопическое лечение

клинический случай

Авторы:

Киселев С.И.

ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России

ORCID: 0000-0002-6872-4721

Конышева О.В.

ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России;
ГБУЗ города Москвы «Городская клиническая больница №15 им. О.М. Филатова Департамента здравоохранения города Москвы»

ORCID: 0000-0002-8064-2761

Дата поступления:

10.03.2023

Дата принятия в печать:

30.03.2023

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