肝癌破裂出血三种治疗方法的对照研究

目的：研究肝细胞肝癌（hepatocellular carcinoma,HCC)自发性破裂出血保守治疗，外科治疗与介入治疗的适应证，禁忌证及方法。方法：对29例HCC自发性破裂出血患者采用三种方法治疗。保守治疗组8例，外科治疗组6例，介入治疗组15例。结果：保守治疗组中1例24h内死于失血怀休克，2例第6天死于肝肾功能衰竭，5例分别生存16天，17天，23天，47天和52天。外科治疗组中2例行肝包膜下淀粉海绵大网膜填塞后1例出血未能彻底控制于次日死亡，1例第7天死于肝肾功能衰竭，另4例行肝动脉结扎术后1例于第9天死于肝功能衰竭，3例分别生存28天，31天和57天，介入治疗组行急诊肝动脉栓塞术（TAE）后出血均得到完全控制。除1例术后第5天死于严重肝肾功能衰竭外，其余14例生存期大于3个月，6个月和12个月者分别为14例，6例和3例，1例随访30个月仍存活。结论：3组中以介入治疗组最为价值，用多种栓塞剂行急诊TAE治疗可使HCC自发性破裂出血立即止血，其适应证宽，创伤小，是安全，可靠，可靠，简便的抢救手段。

Comparative study of three methods treating hepatorrhexis

Objective:To study indications,contraindications and method of different treatments of HCC(hepatocellular carcinoma) spontaneous rupture and bleeding,including medical therapy,surgical therapy and interventional therapy.Methods:29 cases with HCC spontaneous rupture and bleeding were treated by different method,medical treatment 8 cases,surgical treatment 6 cases,interventional treatment 15 cases.Results:The survival period of cases by medical therapy was 24h (died from shock),6 days (2 cases died from hepatocellular failure and renal failure) 16 days,17 days,23 days,47 days and 52 days separately.The survival period of cases by surgical therapy was 1 days (treated with plugging and stiching of liver laceration,died from bleeding) 7 days,9 days (treated with ligation of hepatic artery,died from hepatocellular failure),28 days,31 days and 57 days separately.The mean survival time of cases by interventional therapy was 7 months,the longest survival period was 30 months,one of them died from hepatocellular failure and renal failure.Conclusion:It was suggested that interventional therapy (TAE) should be the treatment of choice in cases with HCC spontaneous rupture and bleeding.