肝细胞癌自发性破裂出血的治疗对策选择(附30例报告)

Therapeutic strategy for spontaneous rupture of primary hepatocellular carcinoma: report of 30 cases

目的探讨肝细胞癌（HCC）自发破裂出血患者在治疗对策上的选择。方法对本院2008年1月-2011年12月收治的30例HCC破裂出血患者的临床资料进行回顾性分析，其中行Ⅰ期手术9例，急诊经导管肝动脉化疗栓塞术（TACE）治疗21例，TACE治疗后再手术切除10例，其余11例均为单纯TACE治疗，从临床治疗效果进行评价分析。计数资料比较采用卡方检验或Fisher′s检验。结果21例经急诊TACE治疗者止血成功率为100%，其中10例患者TACE治疗后2~5周内进行Ⅱ期手术，术后病理证实均为HCC，术后3个月复查均未见腹腔肿瘤种植转移灶，术后1 年存活率70%（7/10）； 9例行Ⅰ期手术切除的患者中，围手术期内死亡2例，3个月内发生腹腔或切口种植转移者5例（5/7），术后1 年存活率44.4%（4/9）；11例单纯TACE治疗患者术后1 年存活率为27.3%（3/11）。急诊TACE联合手术切除HCC破裂出血在提高抢救成功率、减少术后并发症及提高患者生存时间上均优于急诊手术切除及单纯的TACE治疗。结论HCC自发性破裂出血患者应首选急诊TACE治疗，再联合手术切除，可以明显提高抢救成功率和手术切除率，并可显著降低肿瘤腹腔种植转移率，延长患者生存时间。

ObjectiveTo investigate the therapeutic strategy for spontaneous rupture of hepatocellular carcinoma （HCC）. MethodsA retrospective analysis was performed on the clinical data of 30 patients with HCC rupture hospitalized at our hospital from January 2008 to December 2011, including nine patients treated by primary surgical tumor resection and 21 patients treated with emergency transcatheter arterial chemoembolization （TACE）. Of the latter group, 10 patients underwent surgical tumor resection after TACE and the other 11 patients were treated with TACE alone. Treatment outcomes were evaluated and compared. Categorical data were compared using the chi-square test or Fisher′s test. ResultsThe success rate of hemostasis was 100% in the 21 patients treated with TACE, of whom 10 patients received tumor resection within 2-5 weeks after TACE and HCC was confirmed by postoperative pathology. No peritoneal metastasis was noted three months after surgery. One-year survival rate was 70% （7/10）. Of the nine patients treated by primary surgical tumor resection, two died during the perioperative period and five developed peritoneal or port-site metastasis within three months, and one-year survival rate was 44.4% （4/9）. For the 11 cases treated with TACE alone, one-year survival rate was 27.3% （3/11）. ConclusionTACE combined with surgical tumor resection is the preferred emergency treatment for spontaneous rupture of primary HCC. It can significantly increase the success rate of rescuing patients with HCC rupture and tumor resection rate, significantly decrease peritoneal metastasis rate, and prolong the survival of the patients.