肝癌切除术序贯腹腔热灌注化疗在肝癌自发性破裂出血中的临床应用

背景与目的 肝癌自发性破裂出血（SRHCC）是肝癌严重并发症之一。针对SRHCC治疗，首选简单有效的方法快速止血，然后在全身及局部状况允许的情况下进一步治疗，以期挽救患者生命及延长患者生存。本研究探讨肝癌切除序贯腹腔热灌注化疗（HIPEC）在SRHCC中的临床应用价值。方法 回顾性分析玉溪市人民医院肝胆外科2013年5月1日—2021年12月1日期间收治的102例SRHCC患者的临床资料。其中48例行肝切除术序贯HIPEC治疗（观察组），54例行单纯肝切除术治疗（对照组）。比较两组患者的相关临床指标。结果 两组患者术前一般资料、主要手术指标、术后病理、住院时间、腹腔引流管术后留置时间、Clavien-Dindo 2级以上并发症发生率和围手术期病死率、复发后再手术率差异均无统计学意义（均P>0.05）。观察组住院总费用、术后累积无瘤生存率及总生存率均高于对照组（均P<0.05），但腹膜种植转移发生率明显低于对照组（P<0.05）。结论 肝切除序贯HIPEC能降低SRHCC术后腹膜种植转移率，改善术后无瘤生存率及累积总生存率，是一种安全有效治疗方式，具有重要临床应用价值，但具有费用较高的缺点。

Clinical application of sequential hepatectomy and intraperitoneal hyperthermic chemotherapy in spontaneous rupture and hemorrhage of liver cancer

Background and Aims Spontaneous liver cancer rupture and hemorrhage is a severe complication. For the treatment of spontaneous rupture and hemorrhage of liver cancer, the preferred approach is rapid hemostasis using a simple and effective method, followed by further treatment when the overall and local conditions allow, to save the patient''s life and extend their survival. This study aims to investigate the clinical value of sequential hepatectomy and intraperitoneal hyperthermic chemotherapy (HIPEC) in spontaneous rupture and hemorrhage of liver cancer.Methods A retrospective analysis was conducted on clinical data of 102 patients with spontaneous rupture and hemorrhage of liver cancer admitted to the Hepatobiliary Surgery Department of Yuxi People''s Hospital between May 1, 2013, and December 1, 2021. Among them, 48 patients underwent hepatectomy with sequential HIPEC (observation group), while 54 underwent simple hepatectomy (control group). Relevant clinical variables were compared between the two groups of patients.Results There were no statistically significant differences between the two groups in terms of general preoperative information, major surgical parameters, postoperative pathology, length of hospital stay, postoperative drainage tube retention time, the incidence of Clavien-Dindo grade 2 or above complications, perioperative mortality and reoperation rate after recurrences (all P>0.05). The observation group showed higher total hospitalization costs, a higher postoperative cumulative disease-free survival rate and overall survival rate than the control group (both P<0.05).The observation group had a significantly lower incidence of peritoneal seeding metastasis than the control group (all P<0.05).Conclusion Sequential hepatectomy and HIPEC can reduce the incidence of peritoneal seeding metastasis in liver patients with spontaneous rupture and hemorrhage, improve postoperative disease-free survival rate and overall survival rate, and serve as a safe and effective treatment modality with significant clinical value. However, it is associated with higher costs.