肝切除治疗原发性肝癌自发性破裂

Liver resection for spontaneous rupture of primary hepatocellular carcinoma

目的 探讨肝切除治疗原发性肝癌自发性破裂 (简称肝癌破裂 )的作用。方法 分析两所医院 1970年以来采用肝切除术治疗肝癌破裂 2 1例的临床资料。结果 本组男 17例 ,女 4例。平均年龄 4 2 (2 2～ 6 5 )岁。 19例为急症肝切除 ,2例为 2期切除 ,包括左外叶切除 8例 ,左内叶切除 2例 ,左半肝切除 2例 ,右肝部分切除 5例 ,肿瘤切除 4例。本组中Child Paugh肝功能分级A级的 15例 ,B级 6例 ,B级中 1例术后死于肝衰 ,手术死亡率 4 8%。 2 0例生存者 18例获得随访 ,中位生存时间 16个月 ,1,3,5年生存率分别为 6 4 7% ,11 8% ,5 9%。其中 1例已无瘤生存 2 5年 9个月。结论 肝切除是治疗肝癌破裂的最好方法 ,当有可能时应争取施行。肝切除治疗肝癌破裂可能使病人获得长时间生存。

Objective To study the effect of liver resection for spontaneous rupture of primary hepatocellular carcinoma (PHCC). Methods The clinical data of 21 patients with ruptured PHCC treated by liver resection in Xiangya Hospital and Zhongnan Hospital since 1970 were analyzed retrospectively. Results Seventeen males and 4 females with an average age of 42 (22 65) were included in this study. Of the 21 patients, 19 underwent emergent hepatectomy, 2 two stage hepatectomy, including left segmental liver resection in 8 patients, left median lobectomy in 2, left hemihepatectomy in 2, partial right hepatectomy in 5 and tumor resection in 4. There was no operative death in 15 patients with grade A liver function. One of the 6 patients with grade B liver function died of liver failure after the operation. The operative mortality was 4 8%. Eighteen of the 20 survived patients were followed up. The postoperative median survival time was 16 months. The 1 , 3 and 5 year survival rates were 64 7%, 11 8% and 5 9%, respectively. One patient has been alive and free of tumor for 25 years and 9 months. Conclusions Liver resection is the best treatment for ruptured PHCC if it is possible. Meanwhile, it can result in long survival time.