肝动脉化疗栓塞术治疗肝癌破裂出血

Transcatheter hepatic arterial chemoembolization for spontaneously ruptured hepatocellular carcinoma

目的 探讨肝动脉化疗栓塞术 (TACE)在治疗肝癌破裂出血中的临床应用价值。 方法 采用Seldinger技术 ,使用明胶海绵、碘化油加化疗药物混悬剂作为栓塞剂 ,对 14例肝癌破裂出血患者行肝动脉化疗栓塞术。 结果 有活动性出血的 12例中 10例控制出血 ,有效率为 83 3% ( 10 / 12 ) ,2例 4 8h内死于失血性休克 ,院内死亡率为 14 3% ( 2 / 14 )。 1例术后 2个月死于肝功能衰竭 ,1例术后 2个月获二期外科手术切除。随访 10例 ,8例先后接受TACE治疗 1～ 4次 ,平均生存 7 8月 ,1年以上者 5例 ,占 35 7% ( 5 / 14 )。

Objective To investigate the practical value of transcatheter hepatic arterial chemoembolization (TACE) in the treatment of spontaneously ruptured hepatocellular carcinoma. Methods Using Seldinger technique,we treated 14 patients with ruptured hepatocellular carcinoma by TACE, in which a suspension of gelatin sponge, iodide oil and chemotherapeutic agents was used as embolus. Results Of 12 patients with active bleeding, successful hemostasis was achieved in 10 patients, with an effective rate of 83 3% (10/12), and 2 patients died from hemorrhagic shock within 48 hours, with an in-hospital mortality of 14 3% (2/14). One patient succumbed to hepatic failure two months after the TACE, and 1 patient received a radical operation two months after the TACE. Follow-up in 10 patients revealed that 8 patients underwent TACE for 1 ～ 4 times (mean survival time, 7 8 months) and 5 patients existed for more than 1 year (35 7%, 5/14). Conclusions TACE is effective in the management of spontaneously ruptured hepatocellular carcinoma.