原发性肝癌破裂出血的疗效评价

Evaluation of Treatments for the Hemorrhage of Ruptured Hepatocellular Carcinoma

目的探讨肝癌破裂出血的各种诊治方法并评价其疗效。方法回顾性分析42例肝癌破裂出血患者的临床资料。根据治疗方式,分为3组:手术组(A组)14例,单纯介入组(B组)16例,保守治疗组(C组)12例。比较3组的止血率、30天内死亡率及6个月、1年、2年生存率。结果 A、B 2组的止血率分别为100%、93.8%(P>0.05),均高于C组(41.7%)(P<0.05)。30天内死亡率分别为0%、20.0%、66.7%。A组2年存活率为50%,高于B组(12.5%)和C组(0%)(P<0.05)。结论对可行根治性手术的病例,只要严格掌握手术适应症,急诊行根治性肝切除术是安全有效的,应优先选择。对于无法行根治性手术的病例,可采用介入治疗,止血效果确切,亦能有效延长生存期。保守治疗效果差。

Objective To evaluate the treatments for the hemorrhage of ruptured hepatocellular carcinoma（HCC）.Methods The clinical data of 42 patients with the hemorrhage of ruptured HCC were retrospectively reviewed.Patients were divided into three groups according to the therapeutic programs：group A（n=14）,receiving operation;group B（n=16）,receiving interventional therapy only,group C（n=12）,receiving conservative therapy.The successful rate of hemostasis,30-day mortality,6-month,1-year and 2-year survival rates were compared.Results The successful rate of hemostasis in group A,B was 100% and 93.8%（P〉0.05）,which was significantly higher than that in group C（41.7%）（P〈0.05）.The 30-day mortality in group A,B and C was 0%,20.0%,66.7%,respectively.The 2-year survival rate in group A was 50%,which was significantly higher than those in group B（12.5%） and group C（0%）（ P〈0.05）.Conclusion For patients with a resectable HCC,the emergent hepatectomy which is safe and feasible,is recommended as the first choice for the treatment.Interventional therapy can be adopted to prolong survival period for the patients who have no chance of radical resection.