肝癌自发破裂出血时肝切除的时机选择

目的：探讨肝细胞癌自发破裂出血（SRHCC）行肝切除手术时机的选择。方法：回顾性分析10年间我院收治的87例SRHCC患者的临床资料,其中9例行急诊肝切除（E组）,10例行延期肝切除（D组）。结果：E组住院时间明显短于D组,两组患者特征及其余各项指标差异均无统计学意义,均无住院死亡;E组为入院24h内手术,D组从入院到手术的中位时间为3d（2～6d）;E组1、3年总的生存率分别为66.7%、44.4%,D组为70%、30%,两组中位生存期分别为750d、788d（P=0.763,log-rank检验）。结论：经过合适选择的SRHCC患者,急诊肝切除可缩短住院时间,同延期肝切除一样安全有效。

Optimal timing of liver resection in the management of spontaneous rupture of hepatocellular carcinoma

Objective：To explore the optimal timing of liver resection in the management of spontaneous rupture of hepatocellular carcinoma（SRHCC）.Method：A retrospective collection of medical records of 87patients with SRHCC was carried out.Nine patients underwent emergency liver resection（E group）.Ten patients underwent delayed liver resection（D group）.Result：The two groups had similar demographic information and pathophysiological situation before surgery（P0.05）.E group was operated within 24hours after admission.The median time between admission to delayed operation was 3days（range 2～6days）.The length of stay in E group was shorter compared with D group（20.5±2.8vs.17.4±2.9days,P=0.030）.There was no significant difference between E group and D group in hospital mortality（0vs 0）,median survival time（788vs 750days respectively） as well as 1-year and 3-year survival rates（66.7%,44.4% vs 70%,30%,respectively）（P=0.763,log-rank test）.Conclusion：For appropriate selected SRHCC patients,emergency liver resection can reduce length of stay,and is as safe and effective as delayed liver resection.