原发性肝癌导致肝破裂出血诊治体会

Experience of diagnosis and treatment on liver rupture of primary liver cancer

目的:研究及探讨原发性肝癌致肝破裂出血的诊治方法。方法:回顾性研究本院2006年1月～2009年10月收治的肝癌破裂出血患者16例,分析出血原因及诊治方法。结果:手术治疗组13例,其中单纯缝扎2例,1例术后1周发生再出血死亡,1例生存4个月;肝切除术9例,最短生存5个月,最长生存38个月;局部填塞1例生存6个月;缝扎加肝动脉结扎1例存活9个月。术后因再出血性休克并肝功能衰竭死亡1例,上消化道出血1例。经腹动脉超选择性肝动脉栓塞止血3例。生存期分别为6、9、10个月。结论:诊断性腹穿阳性率为100%,对肝癌导致肝破裂出血的诊断意义重大。手术和介入治疗可创造抢救成功机会,合理选择治疗方案是提高远期疗效的有效途径。

Objective：To investigate the diagnosis and treatment on liver rupture of primary liver cancer.Methods：16 cases of liver rupture of primary liver cancer were treated in our hospital from January 2006 to October 2009,retrospective study was used to analyze the reasons and treatment of them.Results：Surgical treatment group 13 cases,in them simple suture operation in 2 cases,one case died of rehaemorrhagia after a week,another survived for 4 months.Partial liver resection operation in 9 cases that survived for 5-38 months after opration.Local stuff operation in 1 case and survived for 6 months.Transfixion and ligature of hepatic artery in 1 cases and survived for more than 9 months,1 case died of hemorrhagic shock and liver failure,1 case died of hemorrhage of upper digestive tract.The survival time of transcatheter hepatic arterial embolization in 3 cases was 6,9,10 months.Conclustion：Diagnostic paracentesis have important diagnostic significance to liver rupture of primary liver cancer.Active operation and embolization can enhance the chance of successful emergency.Reasonable selection of treatment is the key to improve the long-term efficacy.