原发性肝癌自发性破裂出血31例外科治疗分析

Experience in treating 31 cases ofspontaneous rupure and bleeding of primary hepatic carcinoma

目的:探讨原发性肝癌自发性破裂出血的临床表现,治疗方案疗效。方法:对1998年1月到2008年1月我院收治的31例原发性肝癌自发性破裂出血的临床资料进行回顾性分析,并结合文献进行探讨。结果:全组31例中,非手术治疗10例,手术治疗21例,4例行肝动脉结扎加大网膜填塞止血,余17例行肝切除。左肝外叶切除5例,左肝内叶切除2例,左半肝切除2例,肝右叶部分切除8例。非手术组生存时间平均为30±23天,手术组肝动脉结扎加大网膜填塞生存时间平均为199±86天。肝切除组生存453±124天。1、3、5年生存率为75.4%、40.2%、0%。结论:应尽量完善术前检查,及时诊断,严格掌握治疗方法适用症,迅速控制出血,是抢救肝癌自发性破裂出血病人的关键。肝切除是治疗原发性肝癌破裂出血的最好方法。

Objective：To explore the efficacy of treatment and clinical characteristics for spontaneous rupture and bleeding of primary liver cancer. Methods： A retrospective clinical analysis was performed for 31 patients who underwent treatment due to spontaneous rupture and bleeding of primary hepatic carcinoma from January 1998 to January 2008. Results： Ten cases received non - surgical treatment and 21 cases received surgical treatment（4 cases with hepatic artery ligation and greater omentum tamponade to stop bleeding and 17 cases with hepatectomy）. Left lateral hepatic lobectomy in 5 cases,left medial hepatic lobectomy in 2 cases, left hepateetomy in 2 cases, right lobe partial resection in 8 cases. The non - surgical group had average survival time of 30 ± 23 days, and hepatic artery ligation plus greater omentum tamponade group had 199 ± 86 days. Liver resection group had average survival time of 453 ± 124 days,and 1,3,5 - year survival rates were 75.4% ,40. 2% ,0%. Conclusion： Perfect preoperative examination, prompt diagnosis and strict control of the indications of various treatments play a key role in the rescue of spontaneous rupture of hepatocetlular carcinoma patients. Liver resection may be the best treatment for spontaneous rupture and bleeding of primary hepatic carcinoma currently.