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1.
肝切除治疗原发性肝癌自发性破裂   总被引:33,自引:0,他引:33  
目的 探讨肝切除治疗原发性肝癌自发性破裂 (简称肝癌破裂 )的作用。方法 分析两所医院 1970年以来采用肝切除术治疗肝癌破裂 2 1例的临床资料。结果 本组男 17例 ,女 4例。平均年龄 4 2 (2 2~ 6 5 )岁。 19例为急症肝切除 ,2例为 2期切除 ,包括左外叶切除 8例 ,左内叶切除 2例 ,左半肝切除 2例 ,右肝部分切除 5例 ,肿瘤切除 4例。本组中Child Paugh肝功能分级A级的 15例 ,B级 6例 ,B级中 1例术后死于肝衰 ,手术死亡率 4 8%。 2 0例生存者 18例获得随访 ,中位生存时间 16个月 ,1,3,5年生存率分别为 6 4 7% ,11 8% ,5 9%。其中 1例已无瘤生存 2 5年 9个月。结论 肝切除是治疗肝癌破裂的最好方法 ,当有可能时应争取施行。肝切除治疗肝癌破裂可能使病人获得长时间生存。  相似文献   

2.
原发性肝癌自发性破裂的诊断和治疗   总被引:4,自引:0,他引:4  
目的 探讨原发性肝癌自发破裂出血的诊断和治疗,尤其对保守治疗的评估。方法 回顾性总结原发性肝癌自发性破裂出血的诊断和治疗结果。对各种治疗方法和应注意的一些问题进行讨论。结果 27例患者中,6例行保守治疗,术后病死率为66.6%(4/6)。21例行手术治疗,手术方法有不规则肝切除术,肝动脉结扎+填塞缝扎术,单纯填塞缝扎术。其病死率分别为25.0%(1/4),44.4%(4/9),75.0%(6/8)。结论 原发性肝癌自发性破裂出血的患者采用肝切除术是安全的可行的和有效的,保守治疗的患者选择方面还需进一步探讨。  相似文献   

3.
原发性肝细胞癌自发性破裂的治疗(附64例报告)   总被引:10,自引:2,他引:10  
目的 探讨原发性癌自发性破裂(SRHCC)的治疗方法。方法 回顾性分析64例SRHCC病人非手术及手术治疗的疗效。结果 保守治疗14例(21.9%),平均存活时间7d(12h~12d);手术治疗50例(78.1%),其中长纱布填塞31例(48.4%),平均存活时间11d(4h~3个月),1个月存活率3.2%;肝动脉结扎6例(9.4%),平均存活2.5个月(8d~6个月),1个月存活率66.7%;肝动脉栓塞化疗病人1例(1.6%),存活9d;肝切除12例(18.8%),1个月存活率91.7%,1,3,5年存活率分别为66.7%,16.7%,8.3%,平均存活时间36个月(4d~25年3个月),最长1例存活超过25年3个月,目前仍键在。肝切除组中11例Child-Pugh功能A级病人安全度过围手术期,无死亡;1例Child-Pugh功能B级术后4d死于肝衰。结论 SRHCC易于误诊,特别是既往“体健”者。SRHCC并非均为晚期病变,如有可能,早期肝癌破裂肝功能良好者应采取急症手术切除;如病人情况或医疗条件不允许,可行延期或二期手术治疗;对不能切除的晚期病人可采取保守治疗及其它治疗。  相似文献   

4.
原发性肝癌自发性破裂的外科治疗   总被引:9,自引:0,他引:9  
原发性肝癌自发性破裂的外科治疗同济医科大学附属同济医院外科(430030)张志伟,陈孝平肝癌自发性破裂的治疗比较困难,治疗的关键是控制出血与保肝。止血的方法有手术与非手术,但手术止血的效果较为确切。必须指出的是,有些病人出血通过手术控制后,迅即出现黄...  相似文献   

5.
肝癌自发性破裂患者血管超微结构研究   总被引:8,自引:0,他引:8  
Zhu LX  Geng XP  Fan SD 《中华外科杂志》2006,44(3):161-164
目的 通过透射电子显微镜对发生自发性破裂的肝癌小动脉壁进行超微结构检查,进一步证实小动脉病变在肝癌自发性破裂病理变化中的作用。方法 对11例肝癌自发性破裂患者的手术标本与同期随机选取的11例肝癌非破裂患者手术标本进行小动脉壁的透射电子显微镜检查。结果 3例肝癌自发性破裂的患者存在巨噬细胞吞噬功能活跃的现象,而该现象却存在于10例非破裂患者中。肿瘤破裂的患者中,9例患者的小动脉壁表现出血管受损现象,包括:血管内皮细胞发生细胞连接消失、窗口直径过大、血管内皮显示高蛋白合成征象;血管壁弹力膜断裂、弹性硬蛋白过度增生及胶原纤维结构受损,其弹力膜中可见电子沉淀物。在肿瘤非破裂的患者中,上述血管受损现象仅在2例患者中发现。二组患者的巨噬细胞功能受损及血管受损的发生率有显著性差异。结论 肝癌破裂患者中的小动脉病变使其管壁通透性增加、弹性消失及支撑力下降,是发生自发性破裂出血的重要原因。  相似文献   

6.
7.
自发性破裂出血是原发性肝癌的严重并发症,为肝癌患者死亡的四大因素之一[1]。我院于1986.2~1997.10月共收治原发性肝癌自发性破裂出血31例,其中手术治疗28例,现就其治疗结果分析如下:1临床资料本组31例中男26例,女5例。年龄32~67岁,平均56.3岁。术前误诊6例,术前休克15例,保守治疗3例,分别于1~3日内自动出院。手术治疗28例,其中肝部分切除6例,肝动脉结扎13例,单纯填塞止血8例,经股动脉置管肝动脉栓塞1例。术后继续出血2例,2周内死亡4例,其中死于休克1例,肝功能衰竭3例、自动出院2例。获得随访14例,半年内死亡3例,…  相似文献   

8.
原发性肝癌自发性破裂   总被引:1,自引:0,他引:1  
原发性肝癌(HCC)自发性破裂出血发生率约为3%-15%,多见于亚洲及非洲,欧美地区罕见,在亚洲约占HCC死亡原因的10%,且其再出血率高达43%,急性出血期肝衰发生率为12%-42%,死亡率更高达25%-75%。因此,HCC破裂出血的治疗仍是目前临床工作中较为棘手的难题。  相似文献   

9.
原发性肝癌自发性破裂出血   总被引:7,自引:0,他引:7  
詹世林  杨星 《普外临床》1994,9(2):111-116
  相似文献   

10.
肝细胞癌自发性破裂出血是肝癌最严重和致命的并发症。往往因病情险恶,治疗困难,而示预后不良。但若能较早的发现,正确的诊断和采用恰当的治疗,不仅能提高疗效,也会出现长期存活的可能。本文总结我院外科自1982年1月至1989年10月共收治肝细胞癌自发性破裂出血14例,对本病的诊断和治疗进行了探讨。临床资料本组患者男性12例,女性2例,年龄33~60岁。  相似文献   

11.
目的 探讨肝癌自发性破裂的机理。方法 采用文献回顾的方法,对肝癌自发性破裂患者的资料加以综述。结果 肝癌自发性破裂的患者体内抗原抗体复合物积聚并沉积在小动脉壁弹力膜上,在其沉积处的小动脉壁存在血管受损现象。结论 乙肝病毒感染所形成的抗原抗体复合物沉积在血管壁导致小动脉脆性病变,可能与肝癌自发性破裂出血有关。  相似文献   

12.
目的探讨原发性肝癌自发破裂出血治疗方式的选择及价值。方法回顾分析2013年2月至2016年2月我院收治的18例肝癌自发性破裂出血患者的临床资料。结果所有患者常规给予抗休克输血止血治疗,11例行急诊肝切除术,术后均康复出院;5例行单纯介入治疗,其中4例好转出院,1例死亡;内科保守治疗2例,1例好转,1例死亡。结论对于有急诊肝切除指征的病例,应首选急诊手术,对于一般情况差、瘤体过大、肝功能失代偿及不能行肝切除术患者首选急诊介入止血,介入术后选择性肝切除术被认为是肝癌破裂出血患者的有效治疗策略,保守治疗效果差。  相似文献   

13.
目的研究肝癌破裂出血的原因和急性期止血以及止血后Ⅱ期治疗措施。方法对国内、外相关文献进行综述分析。结果肝癌破裂出血的病因目前仍不完全清楚,我国肝癌破裂出血与乙肝病毒感染导致抗原抗体复合物沉积于肿瘤小动脉壁致其损伤继而破裂出血关系密切。治疗方法有保守治疗、手术治疗(肝叶切除、肝动脉结扎术、缝扎填塞)、肝动脉插管栓塞术、其他治疗(无水乙醇瘤内注射、射频消融、生物免疫疗法等)。结论肝动脉插管栓塞术在肝癌破裂出血急性期止血效果良好,可作为Ⅱ期综合治疗的基础。  相似文献   

14.
目的探讨乙肝病毒感染与肝癌自发性破裂出血的相关性及其机理。方法采用文献回顾的方法,对肝癌自发性破裂患者的有关血管病变资料加以整理并综述。结果肝癌自发性破裂患者的小动脉存在管壁受损,这与乙肝病毒感染引起的血管免疫性破坏密切相关。结论乙肝病毒感染引起的血管免疫性破坏可能是肝癌自发性破裂的重要原因。  相似文献   

15.
(Received for publication on Sept. 24, 1998; accepted on July 13, 1999)  相似文献   

16.
Two cirrhotic patients with ruptured hepatocellular carcinoma (HCC), presenting with hemoperitoneum, were successfully treated by elective hepatectomy. Both of these patients, a 67-year-old female and a 76-year-old male, had first been taken to other primary hospitals by ambulance due to hypovolemic shock. They were then found to have a mass of approximately 5 cm in the cirrhotic liver. In the initial management, however, neither any direct hemostasis by surgery nor indirect measures such as transcatheter hepatic arterial embolization were performed in either case. Instead, conservative treatment consisting mainly of fresh blood and plasma transfusions were continued for more than a month until the liver function stabilized. In both hepatectomies, the use of a microwave tissue coagulator resulted in minimal intra-operative blood loss and an appreciably excellent post-operative course. These cases point to the effectiveness of a wait and see policy for selected patients with ruptured HCC.  相似文献   

17.
血管硬化性病变与肝癌自发性破裂的关系   总被引:3,自引:0,他引:3  
目的 探讨血管壁弹性变化与肝癌自发性破裂的相关关系。方法 选用肝癌破裂及未破裂患者的肝癌组织标本各30例,采用免疫组化ABC法及电子显微镜检测其与血管病变有关的因素:第八因子相关抗原因子(vWF因子)、弹性硬蛋白、弹性蛋白酶(中性粒细胞性)。结果与未破裂组相比,肝癌破裂患者中血管内皮vWF因子表达量明显下降,小动脉壁中弹性蛋白酶分布异常、弹性硬蛋白增生过度、弹力膜断裂。vWF因子为血管受损指标之一,并参与凝血过程。上述病变的结果,导致患者小动脉壁脆性增加及凝血功能下降,稍遇外力的作用即易发生血管破裂,进而可导致肿瘤组织的破裂。结论肝癌患者体内的血管壁硬变可能与肝癌肿瘤破裂有关。  相似文献   

18.
Spontaneous rupture of the thoracic aorta is rare. We present a 76-year-old man who developed spontaneous rupture of the aortic arch associated with massive periaortic hematoma and hypovolemic shock. Because the site of rupture could not be identified, emergency hybrid endovascular aortic repair to shield a long segment of the aorta was performed according to the extent and density of periaortic hematoma on axial CT scans. His blood pressure improved just after deployment of the endograft. Rapid diagnosis by CT and prompt control of aortic hemorrhage by endografting salvaged this patient. Three-dimensional (3D) volume-rendered CT images are useful for identifying the site of aortic rupture, but may not be available in an emergency.  相似文献   

19.
Spontaneous rupture of hepatocellular carcinoma: a Western experience   总被引:1,自引:0,他引:1  
BACKGROUND: Spontaneous rupture of hepatocellular carcinoma (HCC) is a life-threatening presentation, with an incidence of <3% of HCC patients in Western countries. The reported overall mortality is < or =50% in Asian countries, where the incidence is 12% to 14%. The aim of this study was to report a single center's experience of patients with ruptured HCC during a 11-year period. METHODS: A retrospective review was performed of all patients who presented with ruptured HCC between 1995 and 2005. Data on clinical features, treatment strategies, and survival outcomes were collected. Statistical methods included univariate analysis and Kaplan-Meier survival estimates with log-rank test. RESULTS: A cohort of 21 patients (15 male and 6 female) was identified. Fourteen (66.6%) patients had histologic evidence of underlying cirrhosis, ad the median age at presentation was 68 years (interquartile range [IQR] 61 to 69). Ten of these patients (71.4%) were hemodynamically unstable at presentation. The mean tumor size was 8.5 cm (range 3 to 13), and there was multifocal disease in 6 (42.8%) patients. The etiology of cirrhosis was hepatitis B infection in 3, hepatitis C in 3, alcohol in 4, and cryptogenic in 4 patients. Initial bleeding control was attempted by transarterial embolization (TAE) in 7 (50%) and by emergency surgery in 7 patients (50%). Four of the operations were performed at referring hospitals, and 3 were performed at our institution. Two patients (14.2%) underwent palliative treatment only. Definitive treatment included resection at emergency surgery in 1, staged hepatectomy in 1, and transarterial chemoembolization in 2 patients. There were 7 patients who were noncirrhotic and had a median age of 51 years (IQR 42 to 60). Of these, 6 (87.5%) were hemodynamically unstable at presentation. Mean tumor size was 9 cm (range 6 to 18) and confined to right lobe in all patients. Primary hemostasis was successfully achieved by TAE in 2 and perihepatic packing in 1 patient. Definitive treatment was provided by emergency hepatectomy in 4 and staged hepatectomy in 3 patients. Patients with cirrhosis (n = 14) had a median survival rate of <30 days. Child-Pugh score at presentation (median 7, IQR 5 to 8) correlated strongly with overall survival (P <.0001). Median survival for noncirrhotic patients was 20 months (IQR 2 to 31). One patient without cirrhosis survived for 122 months without disease recurrence. CONCLUSIONS: Spontaneous rupture of HCC is an uncommon presentation in Western countries. Primary hemostasis, followed by emergency or staged hepatic resection, is the treatment of choice. Median survival in patients initially treated with surgery was better than that observed in patients who underwent initial TAE, although this was not statistically significant. Patients who had no underlying liver disease had better prognosis than those who had cirrhosis.  相似文献   

20.
目的:探讨、评估肝癌自发性破裂的机理、临床诊断及治疗,为临床医师比较、筛选出有效的诊治方法。方法:采用文献回顾的方法对肝癌自发性破裂患者的临床资料加以综合比较、综述。结果:肝肿瘤破裂可能与肝硬变门脉高压、肿瘤组织坏死、凝血功能障碍、肝癌中的动静脉短路等有关。其临床诊断的误诊率较高,超声波及CT检查的阳性率较高。急诊治疗可采用肝动脉插管栓塞,待患者一般情况好转后采用二期手术疗法可取得最好的治疗效果。结论:肝癌自发性破裂并非肝癌晚期患者所特有,其预后取决于及时诊断及治疗的正确与否。  相似文献   

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