肝癌破裂出血的治疗:附35例临床分析

Treatment of spontaneous rupture and hemorrhage of liver cancer:a clinical analysis of 35 cases

目的探讨肝癌破裂出血的治疗方法及疗效。方法回顾分析近9年余收治的3 5例肝癌破裂出血患者临床资料。其中,行根治性手术1 2例(包括介入术后行根治性手术5例),姑息性手术9例,介入治疗1 9例(其中5例术后改行根治性手术)。结果根治性手术组术后彻底止血,1例术后死于肝功能衰竭;姑息性手术组术后再出血3例,其中2例死于肝功能衰竭;介入治疗组再出血1例,发生肝功能衰竭2例,死亡1例。根治性手术1 2例中生存1年者9例,2年者7例,5年者4例;姑息性手术9例中,生存1年者2例,2年者1例;介入治疗组1 4例中生存1年者8例,2年者4例,5年者1例。结论根治性手术切除是治疗肝癌破裂出血的有效方法。介入治疗止血满意,并发症少,能有效地延长患者生存期,可作为不能行切除手术患者的首选治疗方法;行介入治疗止血时可通过血管造影判断有无行根治性手术的可能,以减少不必要的急诊手术探查。

Objective To explore the method and curative effect of therapy for spontaneous rupture and hemorrhage of liver cancer. Methods Thirty-five cases of spontaneous rupture and hemorrhage of liver cancer admitted to our hospital from January 1998 to February 2007 were reviewed. Among them, 12 cases underwent radical operation （including 5 cases of operation after interventional therapy ）, 9 cases had palliative operation and 19 cases received interventional therapy （5 cases had radical operation later ）. Results In the radical operation group, the bleeding completely stopped after operation, but 1 ease died of hepatic failure. In the palliative operation group, 3 cases had re-bleeding and two of them died of hepatic failure. In the interventional therapy group, 1 case had re-bleeding, 2 cases had hepatic failure and one of them died. In the 12 eases of radical operation, there were 9 cases of one-year survival, 7 eases of two-year survial and 4 cases of five-year survival. In 9 cases of palliative operation, there were 2 cases of one-year survival and 1 case of two-year survival. In 14 cases of interventional thei＇apy, the one-year, two-year and five-year survival were 8 cases, 4 cases and 1 case, respectively. Conclusions For spontaneous rupture and hemorrhage of liver cancer, interventional therapy can stop bleeding effectively with less complications, and can prolong survival time, so it can be used as the first choice for patients who have no chance of radical resection. Furthermore, hepatic arteriography can evaluate the possibility of radical operation and avoid unnecessary emergency operation.