肝癌破裂出血急诊治疗策略

目的讨论研究原发性肝细胞肝癌(简称肝癌)破裂出血急诊治疗的策略.方法回顾分析18例肝癌破裂出血急诊治疗经验.治疗方法包括手术切除肿瘤,术中腹腔温热化疗(IPHC)和术后经肝动脉介入栓塞化疗(TACE);姑息治疗方法为术中结扎肝动脉、缝扎或纱布填塞压迫止血.全组随访2年.结果急诊肿瘤切除10例,止血后延期再手术切除肿瘤1例,手术切除率61.11%,姑息性治疗7例.切除组手术死亡率、1年和2年生存率分别为9.09%、81.82%和36.36%;而姑息治疗组分别为28.57%、14.29%和0%(P＜0.05).切除组随访2年,腹腔种植转移率为9.09%,肝内复发率36.36%.结论(1)肝癌破裂出血急诊治疗中肿瘤切除预后优于姑息治疗;(2)本组肝癌破裂出血腹腔种植转移发生率低于10%,腹腔种植转移倾向不应作为放弃手术切除肿瘤的依据;(3)术中减少肿瘤挤压、腹腔温热化疗和术后TACE可降低肝癌复发及转移发生率;(4)专业肝脏外科医生参与手术有助提高临床疗效.

Strategy of emergency approach in hepatocellular carcinoma with spontaneous rupture

Objective To study the strategy of hepatocellular carcinoma (HCC) with spontaneous rupture. Methods 18 cases spontaneous rupture of tumor with acute hemoperitoneum in HCC were analyzed in retrospect. The treatment methods included tumor resection, intraperitoneal hyperthermic chemotherapy (IPHC) during operation and transcatheter arterial chemoembolization (TACE) after operation. The palliative treatment included intraoperative hepatic artery ligation, active bleeding be sutured and tamponade hemostases by pad . All cases were followed for 2 years. Results In 10 of 18, tumors were sected in emergency treatment, a late resection was performed after 4 weeks of emergency suture. The rate of tumor resection was 61.11%,7 of 11 were treated by palliative methods. Mortality of operation, over-all survival of 1 and 2 years were 9.09%, 81.82% and 36.36% in resection group respectively, while in palliative treatment group, they were 28.57%, 14.29% and 0% respectively(P< 0.05). In resection cases, implanting metastasis of peritoneum was 9.09%, intrahepatic recurrence was 36.36%. Conclusion (1) In treatment of spontaneous rupture of HCC, the prognosis of resection is superior to palliative treatment. (2) The rate of implanting metastasis of peritoneum is lesser than 10%. (3) Tumor recurrence and implanting metastasis of peritoneum will be decreased by no pinching for bleeding tumor, and IPHC in operation and postoperative TACE. (4) Specialized surgeon on liver is participating emergency operation beneficial to advancing treatment effectiveness.