原发性肝癌自发性破裂出血

SPONTANEOUS RUPTURE OF PRIMARY LIVER CANCER

目的 探讨原发性肝癌自发性破裂出血的诊断和治疗方法。方法 回顾性分析本院 8年来收治 13例原发性肝癌自发性破裂出血的临床资料。结果 12例急诊行肝癌切除术 ,1例行缝扎止血及肝动脉插管术。术后 1h死于出血性休克 1例。术后随访 11例 ,术后生存小于 12月 2例 ,12 -18个月 3例 ,19-3 0个月 2例 ,3 1-4 2个月 3例 ,>4年者 1例 (术后第 3年亚临床复发再切除病例 )。随访患者最终死亡原因 :癌复发和转移、肝昏迷、上消化道出血和肝肾综合征。结论 肝叶切除和肝脏局部切除不但可以彻底有效地止血 ,而且可以切除肿瘤达到根治的目的 ,是首选的方法。术后的综合治疗采用肝动脉插管化疗栓塞术和腹腔化疗交替应用以预防复发 ,延长患者的生存期。加用免疫治疗 。

Objective To explore the diagnosis and treatment for spontaneous rupture and bleeding of liver cancer.Methods From Nov 1990 to Dec 1998,13 patients with rupture and bleeding of liver cancer were analyed retrospectively.Results Resection of liver cancer in 12 cases.Suture and ligation,liver arterial catheter chemotherapy in 1 case.One case died of shock after operation in 1 hours.Follow up of 11 cases after operation,2 cases survived less than 12 months,3 cases survived for 12 18 months,2 cases survived for 19 20 months,3 cases survived 31 42 months,1 case has survived more than 4 years(Re resection of subclinical recurrence after resection for 3 years).Recurrence and metastases,liver failure,digestive hemorrhage and hepatorenal syndrome are the major reasons of death.Conclusion Lobectomy and minor resection are still the modality of first choice for treatment of spontaneous rupture and bleeding of liver cancer.Comprehensive treatment of postoperation are hepatic arterial catheter chemotherapy and intraperitoneal chemotherapy for prevent recurrence and more survive.Immunotherapy are employed so that the effect may be improved.