原发性肝癌自发性破裂的治疗

Management of Spontaneous Rupture of Hepatocellular Carcinoma

目的分析原发性肝癌(hepatocellular carcinoma,HCC)自发性破裂的治疗效果。方法26例HCC自发性破裂患者,行一期肝切除9例,一期手术止血4例,二期肝切除11例,另2例行介入治疗。结果二期肝切除和一期肝切除比较,术后并发症发生率分别为27.3%和66.7%,无统计学差异(P=0.175);术后30 d、60 d死亡率分别为0%vs 22.2%,0%vs 44.4%,仅术后60 d死亡率有统计学意义,P=0.026;术后1年、3年生存率比较无统计学意义,分别为90.9%vs 44.4%,3.64%vs 22.2%,P>0.05。结论对于自发性破裂HCC,二期肝切除手术近期效果优于一期肝切除手术,但两者远期生存率并无显著差异。一期切除手术对于部分病人仍可取得较好的效果。

Objective To investigate the strategy for spontaneous rupture of hepatocellular carcinoma（HCC）.Methods A retrospective study was performed on 26 patients with spontaneous rupture of HCC,in whom 9 cases underwent emergency hepatectomy,4 of emergency surgical hemostasis,11 of delayed curative hepatic resection,and the other 2 underwent TAE and TAC.Results The complication rate of delayed and emergency hepatectomy was 27.3% and 66.7% respectively（P=0.175）.And the 30-,60-day mortality were 0% VS 22.2%,0% VS 44.4% respectively,in which the 60-day mortality of the delayed hepatectomy group was better（P=0.026）.The 1-and 3-year survival rates were 90.9% VS 44.4%,36.4% VS 22.2% respectively（P〉0.05）.Conclusion Delayed hepatectomy favoreds better short-term results when compared with emergency hepatectomy,although long term survival seems similar.