肝癌自发性破裂出血的诊断与治疗

Diagnosis and Treatment for Spontaneous Rhexis Hemorrhage of Liver Cancer

目的探讨肝癌自发性破裂出血的诊治方法。方法回顾性总结资阳市第一人民医院和雁江区人民医院1995年1月至2009年3月期间收治的30例肝癌自发性破裂出血患者的临床资料。结果经手术治疗的26例全部达到止血目的,其中行肝癌切除术14例,出血局部缝扎加肝动脉结扎或插管10例,大网膜填塞缝扎2例;术后1周内死亡4例,15 d死亡1例,1-3个月内死亡9例;生存4-6个月有5例,7-12个月3例,12个月以上4例（其中生存16个月死亡1例,生存5年死亡1例,现仍存活并已生存3年1例、13年1例）。4例行非手术治疗者于入院后3-14 d死亡。结论肝癌自发性破裂出血不是肝癌的终末期,早诊断、早手术可有效止血,手术治疗优于非手术治疗,不失时机地行肝肿瘤切除可提高远期生存率。

Objective To explore the diagnosis and treatment for spontaneous rhexis hemorrhage of liver cancer.Methods Clinical data of thirty patients who suffered from spontaneous rhexis hemorrhage of liver cancer from January 1995 to March 2009 were collected and analyzed retrospectively.Results Twenty-six cases were stanched by surgical therapy,in which 14 cases underwent liver cancer resection,10 cases underwent bleeding transfixion and hepatic artery ligation（or intubation）,and 2 cases underwent omentum stuff transfixion.Four cases died one week after surgery,one died after 15 d,9 cases died 1 to 3 months after operation,5 cases survived after 4 to 6 months,3 cases survived after 7 to 12 months,and in 4 cases survival time was longer than 12 months（in which one patient＇s survival time was 16 months,one was 5 years and two patients were still alive with survival time of 3 and 13 years respectively）.Four patiens went through the non-surgical therapy and survival time was 3 to 14 d.Conclusion The spontaneous rhexis hemorrhage of the liver cancer is not the telephase of the liver cancer.Early diagnosis and operation can stanch bleeding effectively.The surgical therapy is better than the non-surgical therapy.Resection of liver neoplasms in time can raise long-term survival time.