28例原发性肝癌自发破裂出血的诊治经验

目的:探讨原发性肝癌自发破裂出血的发生机制,临床特点及诊治原则.方法:回顾性分析1990年10月～2000年10月行急诊剖腹手术治疗的28例原发性肝癌自发破裂出血患者的临床资料.结果:自发破裂出血多发于男性原发性肝癌患者,17例(61%)有肝炎病史,25例(89%)合并肝硬化.突发右上腹剧痛22例(79%),休克23例(82%),腹膜刺激症27例(96%).腹腔穿刺、B超及CT的诊断阳性率分别为82%、75%、91%.术中见肿瘤呈肿块型17例,结节型11例.术式分别为单纯修补2例,填塞压迫2例,肝动脉结扎2例,肝叶切除11例,单纯微波固化5例,微波固化加填塞压迫3例,微波固化加肝动脉结扎3例.7例出现术后合并症,分别为肝功能衰竭4例,肾功能衰竭1例,肺内感染l例,切口裂开1例.全组病例平均生存期7个月,主要死因为肝功能衰竭和食管静脉曲张破裂出血.结论:原发性肝癌自发破裂出血机制不清,急诊剖腹手术可以使部分患者Ⅰ期切除肿瘤,具有止血效果确切,再发出血率低的优点.预防肝功能衰竭是改善预后的关键.

The Diagnosis and Treatment of Spontaneous Rupture of Primary Hepatocellalur Carcinoma

Objective: This study retrospectively evaluated our experience of emergency laparotomy in the management of spontaneous ruptured hepatocellalur carcinoma(HCC). Methods: Retrospective analysis documented 28 cases with spontaneous rupture of HCC who received emergency laparotomy from 1990 to 2000 in the Surgery Department of the Second Hospital of China Medical University. Results: 17 cases (61%) had viral hepatitis background and 25 cases (89%) were accompanied with liver cirrhosis. The most frequent manifestation was sudden right hypochondrial or epigastric pain, which was presented in 27 cases (96%). Shock was seen in 23 cases (82%), and 27 cases (96%) had signs of peritonitis. The methods of operation were performed as following: suture in 2 cases; packing in 2 cases; hepatic artery ligation in 2 cases; hepatectomy in 11 cases; microwave coagulation in 5 cases; microwave coagulation combining with packing in 3 cases; microwave coagulation combining with hepatic artery ligation in 3 cases. The morbidity from the laparotomy occurred in 7 cases (25%). The overall hospital mortality rate was 18%. The mean survival time was 7 months. The main causes of death were liver failure and massive variceal bleeding. Conclusions: Spontaneous rupture of HCC represents a life-threatening condition and the overall prognosis is poor. Laparotomy is an effective and reliable method in hemostasis. Liver failure is the vital factor of prognosis.