原发性肝癌自发性破裂一期手术切除

目的探讨、研究原发性肝癌自发性破裂的手术切除和围术期处理技术。方法回顾性总结了1993年1月～2003年8月施行肝癌切除术的32例自发性破裂肝病例,并以同期随机抽取32例非破裂肝癌病例作为对照,综合比较、分析两组病人的术前、中、后的临床资料。结果破裂与非破裂组术前肝功能Child鄄Pugh分级、肿瘤包膜及门静脉浸润,术中肝门阻断时间、术时及住院时间的差异无显著性。破裂组肝脏的肿瘤直径、术中失血量、输血量、术后并发症发生率及住院病死率均较非破裂组显著高。多元统计回归分析显示术中失血量是决定原发性肝癌自发性破裂病人术后并发症发生率之独立因素。进一步分析控制术中失血的方法选择,各组间差异无显著性,但Pringle手法居首位。结论原发性肝癌自发性破裂病人是否作一期手术切除在于术前准确评估及术中能否采用恰当方法有效地控制出血。

Emergency surgical resection for spontaneous rupture of hepatocellular carcinoma

Objective To study the technique of surgical resection and perioperative management of rupture of primary heptocellular carcinoma. Methods Thirty-two cases of spontaneous rupture of hepatocellular carcinoma that received emergency hepatectomy between Janunary 1993 and December 2003 were analysed retrospectively, and compared to 32 cases of elective hepatectomy for hepatocellular carcinoma during the same period. Results The diameter of tumor, intraoperative transfusion volume, postoperative morbidity rate and postoperative mortality rate of the spontaneous rupture case were significantly higher than the controls. However, The Child-Pugh grades of liver function, state of encapsulation of the carcinoma, status of portal vein erosion, duration of portal clamping, duration of operation and duration of hospitalisation presented no significant difference between the 2 groups. Multivariable regression analysis showed, the intraoperative blood loss was the independent risk factor of postoperative morbidity rate. By comparing various methods for hemorrhage control, Pringle's manoeuver was found to be the most effective measure. Conclusions The decision as whether or not the spontaneous rupture of hepatocellular carcinoma should be operated on emergency has to be weighed carefully, and that the effective method of control of intraoperative blood loss should be applied.