37例原发性肝癌自发性破裂出血的治疗

目的探讨原发性肝癌自发性破裂出血的治疗方法及疗效。方法回顾性分析37例原发性肝癌自发性破裂出血治疗的临床资料。结果37例患者中,男31例,女6例,平均年龄52.5岁;手术治疗34例,其中一期肝癌切除9例,围手术期死亡2例(22.22%),l年生存率66.67%(6/9);肝动脉栓塞(TAE)止血后二期肝癌切除11例,围手术期死亡0例,1年生存率90.91%(10/11);肝动脉结扎和(或)填塞止血术10例,围手术期死亡5例(50.00%),l年生存率30.00%(3/10);TAE止血后不愿手术或开腹无法手术切除者4例,围手术期死亡0例,l年生存率50.00%(2/4);保守治疗3例,住院期间死亡2例,l年生存率为0;对顺利出院后的患者均予行TACE(肝动脉灌注化疗栓塞)等综合治疗。结论肝癌自发性破裂应遵循个体化综合治疗,肝切除术尤其是二期手术治疗肝癌自发性破裂可能获得良好预后。

EXPERIENCE IN TREATING 37 CASES OF SPONTANEOUS RUPTURE AND BLEEDING OF PRIMARY HEPATIC CARCINOMA

Objective To explore the treatment and efficacy for spontaneous rupture and bleeding of primary liver cancer. Methods A retrospective clinical analysis was performed for 37 patients who underwent treatment due to spontaneous rupture and bleeding of primary hepatic carcinoma. Results 37 cases with spontaneous rupture of primary bepatoceUular carcinoma was found in resection,among which male 31 ,female 6 ,average age 52. 2 years; 34 cases received surgery treatment,with 9 of first phase hepatocareinoma resection, perioperative death of which was two cases （22. 22% ） ,had 1 - year survival rate of 66.67% （6/9）. Secondary operation of 11 cases followed the hepatic artery embolization （TAE） to stop bleeding,with perioperative mortality of 0 cases （0） and 1 -year survival rate of 90. 91% （10/11）. Hepatic artery ligation and （or） packing hemostasis of 10 cases to stop bleeding, perioperative death of five cases （50. 00% ）, 1 - year survival rate of 30. 00% （3/10）. There were 3 eases with conservative treatment,2 cases of death during hospitalization,1 -year survival rate was 0. All patients performed a comprehensive treatment of TACE after smoothly discharged from hospital. Conclusion Spontaneous rupture of hepatocellular carcinoma should follow individualized comprehensive treatment. Liver cancer resection ,especially secondary surgical treatment of spontaneous rupture of hepatic carcinoma may be procuring a good prognosis.