失代偿期肝硬化合并进展期原发性肝癌自发性破裂出血行经导管肝动脉栓塞的疗效分析

目的比较经导管肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)与单纯内科保守治疗对失代偿期肝硬化合并进展期原发性肝癌自发性破裂出血的疗效。方法回顾性分析147例失代偿期肝硬化合并进展期原发性肝癌自发性破裂出血患者的临床资料,其中92例行单纯内科保守治疗(保守治疗组),55例行TACE联合内科保守治疗(TACE+保守治疗组);比较2组24 h止血效果和死亡原因的差异。结果 TACE+保守治疗组与保守治疗组治疗后24 h内出血停止的比例分别为83.6%和64.1%(P0.05),在死亡原因及中位生存期方面2组差异无统计学意义。结论失代偿期肝硬化合并进展期原发性肝癌自发性破裂出血患者行TACE治疗虽然近期止血效果优于内科保守治疗,但对延长患者的生存期无显著改善。

Therapeutic effect of transcatheter arterial chemoembolization on spontaneous rupture and hemorrhage in patients with decompensated cirrhosis complicated by advanced primary liver cancer

Objective To assess the therapeutic effect of transcatheter arterial chemoembolization （TACE） and medical treat-ment on spontaneous rupture and hemorrhage of hepatocellular carcinoma in patients with decompensated cirrhosis complicated by advanced primary liver cancer. Methods Clinical data of 147 decompensated cirrhotic patients with spontaneous rupture and hem-orrhage of primary hepatocellular carcinoma were analyzed retrospectively. Among the 147 patients, 92 received medical treatment （medical treatment group） and 55 received TACE in addition to medical treatment （TACE＋medical treatment group）. The effect on stopping bleeding during 24 hours and the causes of death were compared between the two groups. Results The rates of stopping bleeding during 24 hours were 83.6% and 64.1%, respectively, in TACE＋medical treatment group and medical treatment group （P＆lt;0.05）. The differences in the causes of death and median survival were not significant between the two groups. Conclusions Although short-term effect of TACE on stopping bleeding is superior to that of medical treatment in patients with decompensated cirrhosis com-plicated by advanced primary liver cancer suffering from spontaneous rupture and hemorrhage of hepatocellular carcinoma, TACE shows no improvement in prolonging survival in those patients.