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肝癌自发性破裂出血22例的治疗 总被引:2,自引:0,他引:2
自发性破裂出血是原发性肝癌严重的并发症,病情危急,且易误诊,处理较难。我院从1980年—1999年共收治22例,现就其诊断和治疗加以分析讨论。1 临床资料1.1 一般资料 本组22例中,男性19例,女性3例,年龄最小为28岁,最大为76岁,平均年龄48岁。起病主要症状为腹痛,表现为右上腹突发性疼痛7例,转移性右下腹痛6例,中上腹疼痛9例。入院后体检,满腹压痛伴肌紧张16例,局限右下腹压痛、反跳痛6例。生命体征尚稳定10例,12例合并休克。进行腹腔穿刺10例,8例有不凝血。1.2 治疗与结果 22例中14例当日急诊剖腹探查,2例次日手术。其中肝部分切除5例;肝… 相似文献
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原发性肝癌自发性破裂出血介入动脉栓塞治疗 总被引:4,自引:0,他引:4
目的:研究原发性肝癌自发性破裂出血介入动脉栓塞治疗的方法。方法:回顾性分析对18例肝癌破裂出血患者采用急诊介入栓塞止血。结果:本组18例患者均得以有效止血。1例患者在3天后由于严重休克肝动脉栓塞治疗死于肝、肾衰竭。其余均无复发出血及急性肝功能衰竭。8例门静脉部分或完全阻塞患者经肝动脉栓塞(TAE)治疗后未出现肝功能衰竭。5例患者在栓塞术后3~7天内成功被施行肝肿瘤切除术。12例患者被明胶海绵栓塞术后,根据病情多次行介入治疗,肿瘤均有不同程度的缩小和坏死。结论:TAE是治疗肝癌破裂出血的有效方法,可达到立即止血的目的,同时可为肝癌后续血管内治疗提供途经。 相似文献
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肝癌自发性破裂的治疗分析 总被引:2,自引:0,他引:2
总结283例原发性肝癌自发性破裂的治疗结果。非手术治疗163例,AFP转阴率为0,多数1月内死亡,6月生存率1,2%;手术治疗120例,其中单纯止血59例AFP转阴率、6月、1年生存率分别为2.4%、76.1%、3.6%;止血后并用肝动脉插管治疗24例,AFP转阴率、6月、1、2年生存率分别为37.5%、79.1%、58.3%、17.4%;肝叶切除37例,AFP转阴率、6月、1、2、3年生存牟分别为68.o%、86.5%、45.9%、26.5%、10.8%。提示肝癌自发性破裂出血,手术治疗优于非手术治疗,肝叶切除优于止血治疗,止血后并用肝动脉插管治疗优于单纯止血治疗。 相似文献
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目的:探讨原发性肝癌自发性破裂出血的临床表现,治疗方案疗效。方法:对1998年1月到2008年1月我院收治的31例原发性肝癌自发性破裂出血的临床资料进行回顾性分析,并结合文献进行探讨。结果:全组31例中,非手术治疗10例,手术治疗21例,4例行肝动脉结扎加大网膜填塞止血,余17例行肝切除。左肝外叶切除5例,左肝内叶切除2例,左半肝切除2例,肝右叶部分切除8例。非手术组生存时间平均为30±23天,手术组肝动脉结扎加大网膜填塞生存时间平均为1994-86天。肝切除组生存453±124天。1、3.5年生存率为75.4%、40.2%、0%。结论:应尽量完善术前检查,及时诊断,严格掌握治疗方法适用症,迅速控制出血,是抢救肝癌自发性破裂出血病人的关键。肝切除是治疗原发性肝癌破裂出血的最好方法。 相似文献
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目的:探讨原发性肝癌自发性破裂出血的临床表现,治疗方案疗效.方法:对1998年1月到2008年1月我院收治的31例原发性肝癌自发性破裂出血的临床资料进行回顾性分析,并结合文献进行探讨.结果:全组31例中,非手术治疗10例,手术治疗21例,4例行肝动脉结扎加大网膜填塞止血,余17例行肝切除.左肝外叶切除5例,左肝内叶切除2例,左半肝切除2例,肝右叶部分切除8例.非手术组生存时间平均为30±23天,手术组肝动脉结扎加大网膜填塞生存时间平均为199±86天.肝切除组生存453±124天.1、3、5年生存率为75.4%、40.2%、0%.结论:应尽量完善术前检查,及时诊断,严格掌握治疗方法适用症,迅速控制出血,是抢救肝癌自发性破裂出血病人的关键.肝切除是治疗原发性肝癌破裂出血的最好方法. 相似文献
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《European journal of surgical oncology》2019,45(9):1652-1659
IntroductionSpontaneous rupture of HCC (srHCC) is a life-threatening sequela of HCC characterized by a high mortality. Liver resection (LR) is the ideal therapeutic strategy as it not only arrests hemorrhage but also remove the offending tumour. We sought to determine the impact of spontaneous rupture on the survival outcomes of patients after LR by performing a propensity score matched (PSM) analysis comparing patients who underwent LR for srHCC versus non-ruptured (nrHCC).MethodsFrom 2000 to 2015, a total of 67 patients who underwent LR for srHCC which met the study criteria were included. 1:2 PSM was performed comparing 49 of 67 patients with srHCC with 98 nrHCC selected from a cohort of 724 patients who underwent LR during the study period.ResultsMedian survival following LR for srHCC was 21.9 months, while 5-year overall survival (OS) and disease-free survival (DFS) was 43.1% and 19.4% respectively. After 1:2 PSM analysis, there was no significant difference between LR for srHCC (n = 49) versus nrHCC (n-98) in terms of OS [21.9 (interquartile range (IQR), 11.8–44.0 vs 27.4 (IQR, 6.9–57.8) months, HR 1.02, CI 0.63–1.66, p = 0.94], DFS [11.8 (IQR, 5.6–25.6) vs 13.77 (IQR,4.5–34.9) HR 0.74, CI 0.54–1.02, p = 0.06] and length of stay [8 (IQR, 7–11) vs 7 (IQR, 6–10) HR 0.93, CI 0.0.68–1.29), p = 0.68].ConclusionLR for clinically stable patients with srHCC provides survival and recurrence outcomes that are comparable to patients with nrHCC. 相似文献
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肝动脉插管栓塞治疗原发性肝癌自发破裂出血的疗效评价 总被引:19,自引:0,他引:19
目的 探讨经肝动脉插管栓塞 (TAE)治疗原发性肝癌自发破裂出血的临床价值。方法42例原发性肝癌自发破裂出血患者 ,根据治疗方法的不同分为 4组 :A组 15例 ,TAE后择期部分肝切除 ;B组 11例 ,单纯TAE治疗 ;C组 6例 ,急诊手术治疗 ;D组 10例 ,内科保守治疗。结果 A、B两组2 6例患者治疗前腹腔动脉造影 ,有 7例可见造影剂外渗 (2 6 .9% ) ,其余为富血供肿瘤染色。A、B、C3组的止血成功率 (10 0 % )明显高于D组 (4 0 % ,P <0 .0 5 ) ,3组的住院死亡率分别为 0 ,3.8%和 16 .7%(P≥ 0 .2 86 ) ,明显低于D组的 80 .0 % (P <0 .0 1)。A组 1年存活率为 76 .3% ,明显高于B组 (4 7.5 % )和C组 (4 3.7% ,P <0 .0 5 )。D组未有生存超过 1年者 ,与前述 3组差异有极显著性 (P <0 .0 1)。结论TAE是原发性肝癌破裂急诊止血的有效、安全方法。对可切除的肝癌患者 ,TAE后择期手术切除应作为首选治疗方案。 相似文献
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目的:探讨肝癌自发破裂出血的诊治方法。方法:回顾性分析我院1995年1月-2007年5月间收治的29例肝癌自发破裂出血患者的临床资料。开腹手术16例,其中行肝脏部分切除10例,单纯缝扎3例,局部填塞2例,缝扎加肝动脉结扎1例。介入治疗9例,其中3例术后再行开腹手术治疗。保守治疗4例。结果:死亡5例,其中开腹手术1例,介入治疗1例,保守治疗3例。开腹手术患者1年生存率43.8%(7/16),介入治疗33.3%(3/9),保守治疗0.0%(0/4)。结论:积极手术及介入治疗可增加抢救成功机会,合理选择治疗方案是提高远期疗效的关键。 相似文献
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Kondo S Okusaka T Ueno H Ikeda M Morizane C 《International journal of clinical oncology / Japan Society of Clinical Oncology》2006,11(5):407-411
We report four patients with hepatocellular carcinoma (all men, with liver cirrhosis and hepatitis C virus infections) who
showed spontaneous regression of the tumor. When the spontaneous regression occurred all of the patients were over age 67
years. They showed a rapid increase of serum alpha-fetoprotein levels just before the spontaneous regression of hepatocellular
carcinoma. In all the patients, the alpha-fetoprotein level decreased to within normal limits and the tumor was partially
to completely reduced in size. One patient revealed regression after bleeding of esophageal varices and blood transfusion.
Another showed spontaneous regression after taking several complementary and alternative medicines. However, the mechanisms
underlying this intriguing phenomenon remain unknown. 相似文献
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超早期肝动脉栓塞抢救肝癌破裂出血的临床意义 总被引:5,自引:0,他引:5
目的研究经导管肝动脉栓塞(TAE)抢救肝细胞肝癌(hepatocellular
carcinoma,HCC)自发性破裂出血的方法及效果。方法对15例HCC自发性破裂出血患者行急诊肝动脉插管,联合运用明胶海绵,碘油,真丝线段,弹簧钢圈作出血动脉分支栓塞治疗。结果15例行TAE后出血均得到完全控制。除1例术后第5天死于严重肝肾功能衰竭外,其余14例均存活3月以上,1例随访30个月仍存活。结论用多种栓塞剂行急诊TAE治疗可使HCC自发性破裂出血立即止血。其适应症宽,创伤小,是安全、可靠、简便的抢救手段,且明显优于外科方法。 相似文献
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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 分析我院1973年以来采用肝切除术治疗肝癌破裂12例的临床资料。结果 本组男10例,女2例。平均年龄42(22—65)岁。11例为急症肝切除术,1例为2期肝切除,包括肝左外叶切除6例,左内叶切除1例,左半肝切除1例,右肝部分切除2例,肿瘤局部切除2例。本组中Child-Paugh肝功能分级A组的11例中无死亡;B组者1例术后死于肝衰,手术死亡率为8.3%。术后生存的1例均获随访,平均生存时间为16.5个月,1,3,5年生存率分别为72.7,18.2%,9.1%。其中1例已无瘤生存25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患者获行长时间生存。 相似文献
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Treatment of ruptured hepatocellular carcinoma 总被引:8,自引:0,他引:8
Tanaka A Takeda R Mukaihara S Hayakawa K Shibata T Itoh K Nishida N Nakao K Fukuda Y Chiba T Yamaoka Y 《International journal of clinical oncology / Japan Society of Clinical Oncology》2001,6(6):291-295
Background. The problem of whether surgical or conservative treatment is indicated for ruptured hepatocellular carcinoma (HCC) has not
been analyzed from the viewpoint of long-term development of hepatitis viral infection from liver fibrosis to liver cirrhosis.
Although transcatheter arterial embolization (TAE) for hemostasis followed by two-stage hepatectomy has been established as
the best treatment for ruptured HCC, there still remain difficulties in the treatment of some patients.
Methods. Twelve patients with ruptured HCC who were surgically or conservatively treated were retrospectively analyzed in terms of
modality of treatment, liver function, extension of HCC, complications, survival rate, and cause of death.
Results. Tumor rupture can occur either in the early phase or in the terminal phase during the development from liver fibrosis to
liver cirrhosis, while tumor rupture occurs at the advanced stage in terms of HCC extension. TAE for emergent hemostasis or
prevention of re-bleeding was performed in ten patients, while TAE was contraindicated in one patient and emergent laparotomy
for hemostasis was performed in one patient. In four patients, elective extended surgical resection was performed, because
liver function was evaluated as clinical stage 1 according to the General rules for the clinical and pathological study of primary liver cancer of the Liver Cancer Study Group of Japan. In seven patients, conservative or medical treat-ment was selected, because liver
function was evaluated as poor. The surgically treated group, who could tolerate extensive operation, survived longer than
the conservatively treated group.
Conclusions. While TAE remains the best method to employ for hemostasis, it still has limitations. Hence, we should be mindful of other
possible modalities for hemostasis and their outcomes. Rupture of HCC at an early phase in the development of liver fibrosis
is a good indication for elective surgical treatment and should be distinguished from rupture in the terminal phase of liver
cirrhosis, which should be treated conservatively. Although elective surgical treatment can be performed in selected patients,
tumor size and location of HCC, in addition to liver function, should be taken into consideration.
Received: December 25, 2000 / Accepted: October 9, 2001 相似文献
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目的探讨原发性肝癌自发性破裂大出血介入治疗的临床疗效及安全性。方法回顾性分析2005年4月至2010年4月收治的71例原发性肝癌自发性破裂大出血患者的临床资料,按照其治疗方式进行分组,介入组患者48例,手术组患者23例,比较两组患者的临床疗效及安全性。结果两组患者腹腔积血、止血成功率差异无统计学意义(P〉0.05),介入组患者治疗过程中出血及接受输血量显著低于手术组患者(P〈0.05)。介入组患者并发症发生率为8.3%(4/48),手术组患者并发症发生率为65.2%(15/23),介入组患者并发症发生率显著低于手术组。两组患者1年生存率差异无统计学意义(P〉0.05),介入组患者2年、3年生存率均显著高于手术组,差异有统计学意义(P〈0.05)。结论介入治疗可达到有效的控制出血、预防再出血作用,同时,该方法能够有效保证患者的生存率,安全性良好,在今后急诊治疗时应将介入治疗作为首选方案,以改善患者的预后。 相似文献
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目的 肝癌自发性破裂在亚洲的发病率较高,且发病机理不详。在我们既往的研究中,首次发现抗原抗体复合物血管壁沉积及血管受损与其破裂有关。该研究中,对小动脉周围的弹性硬蛋白进行了深入的探讨,以进一步核实我们的前期发现。方法 用免疫组化及投射电子显微镜的方法,对23例肝癌破裂及30例肝癌非破裂的手术标本进行检测。结果 在肝癌破裂组,患者小动脉的周围弹性硬蛋白厚度明显增厚,弹性硬蛋白增生、弹性蛋白酶异常分别及胶原纤维降解现象广泛存在;同时亦可发现弹性硬蛋白中的电子密度沉积物及中性粒细胞由血液浸入血管壁的现象;弹性硬蛋白中的电子密度沉积物代表了抗原抗体复合物的沉积,而中性粒细胞的浸润则将导致血管受损。由于受损后的血管将变得脆弱并易于破裂及腹腔内出血,因此推测预先存在于血管壁的抗原抗体复合物沉积及血管受损将与肝癌破裂有关。结论 抗原抗体复合物的血管壁沉积及其导致的血管受损与肝癌破裂有关。 相似文献