不同方法治疗原发性肝癌自发破裂出血的疗效比较

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 50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四组：TAE后择期部分肝切除（A组）12例；单纯TAE治疗（B组）12例；急诊手术治疗（C组）13例；保守治疗组（D组）13例。结果A、B两组患者治疗前腹腔动脉造影．有6例可见造影剂外渗（25％），其余为富血供肿瘤染色。A、B、C三组的止血成功率（100o,6）明显高于D组（40％，P〈0．05），三组的住院死亡率分别为0、4％和17％（P：0．286），明显低于D组的60％（P〈0．01）。A组1年存活率为76％，明显高于B组（48％）和C组（44％）。D组未有生存期超过1年者，与前述三组差异有统计学意义（P〈0．01）。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。

The curative effect of hemorrhage due to spontaneous rupture in hepatocellular carcinoma by different methods

Objective To evaluate the efficacy of transarterial embolization(TAE) for intraperitoneal hemorrhage due to spontaneous rupture in hepato-cellular carcinoma(HCC).Methods 50 cases with ruptured HCC were divided into 4 groups according to the type of their previous treatment:group A,TAE followed by elective hepatectomy 12;Group B,TAE alone 12;Group C,emergency operation 13;Group D,medical conservative management.Results Celiac arterio-graphy done before the present treatment showed extravasation of contrast material in 6(25%) of the 24 patients in group A and B,and hypervascular tumor was observed in the rest.The hemostasis success rate of group A,B and C were 100%,which were much higher than that of group D(40%)(P<0.05).The in-hospital mortality rates of group A,B and C were 0,4% and 17%(P=0.286),which were much lower than that of group D(60%)(P<0.01).The 1-year survival rate of group A(76%) was higher than those in group B(48%) and C(44%).There was no 1-year survivor in group D.Conclusion Transarterial embolization is safe and effective for hemorrhage due to spontaneous rupture in hepatocellular carcinoma.For resectable lesions,TAE is a preferential treatment to be given first,then followed by elective hepatectomy.