原发性肝癌破裂出血的急诊治疗策略

Strategy of emergency treatment in primary liver cancer with rupture and bleeding

目的探讨原发性肝癌破裂出血的急诊治疗策略.方法回顾性分析我院1992年～2003年收治的1 5例原发性肝癌破裂出血病人的诊断及治疗结果.15例病人均行手术治疗.手术方法有不规则肝切除术、肝动脉结扎术、填塞+肝动脉结扎术、填塞及缝合止血、无水乙醇瘤内注射.结果术后死于肝功能衰竭2例,因再出血休克死亡1例,因肝、肾功能衰竭死亡1例.结论肝癌破裂出血的治疗应以止血和保肝为主,同时遵循治疗肝癌的基本原则.选用不同治疗方法必须个体化.

Objective To study the strategy of emergency treatment in primary liver cancer with rupture and bleeding. Methods The diagnosis and treatment of 15 patients with rupture and bleeding of primary liver cancer were analyzed retrospectively. All of the 15 cases were subjected to surgical treatments, including hepatectomy, hepatic arterial ligation, packing plus hepatic arterial ligation, packing and suturing,intratumor injection of absolute alcohol. Results In the 3 cases subject to hepatectomy,one died from hepatic failure. In the 4 cases subject to hepatic arterial ligation,one case died from hepatic failure. In the 4 cases subject to packing plus hepatic arterial ligation, one case died from rehemorrhagic shock. In the 3 cases subject to packing plus suturing, one case died from hepatic and renal failure. Conclusion The most important managements of rupture and bleeding of the liver cancer are hemostasis and protecting liver function. At the same time, the therapeutic basic principle of liver cancer should be followed. The selection of therapeutic methods must be individualization.