18例肝癌自发性破裂出血治疗体会

The Analysis of Treatment of 18 Cases of Spontaneous Rupture of Hepatocellular Carcinoma

目的探讨原发性肝癌自发破裂出血治疗方式的选择及价值。方法回顾分析2013年2月至2016年2月我院收治的18例肝癌自发性破裂出血患者的临床资料。结果所有患者常规给予抗休克输血止血治疗,11例行急诊肝切除术,术后均康复出院;5例行单纯介入治疗,其中4例好转出院,1例死亡;内科保守治疗2例,1例好转,1例死亡。结论对于有急诊肝切除指征的病例,应首选急诊手术,对于一般情况差、瘤体过大、肝功能失代偿及不能行肝切除术患者首选急诊介入止血,介入术后选择性肝切除术被认为是肝癌破裂出血患者的有效治疗策略,保守治疗效果差。

Objective To explore the effect of treatment of spontaneous rupture of hepatocellular carcinoma（HCC）. Methods The clinical data of 18 cases of spontaneous rupture of HCC between February 2013 and February 2016 was summarized and retrospec- tively analyzed in our hospital. Results All the patients were given a blood transfusion,anti-shock and hemostasis therapy routinely. Among them, 11 cases underwent radical operation, who are rehabilitation and discharge from hospital. Emergent transcatheter arterial embolization （TAE） was performed in 8 cases, including one death. Conservative treatment was applied in 2 eases, which also have one death. Conclusion For patients with a resectable HCC, the emergent hepatectomy is recommended as the first choice for the treatment. TAE can effectively induce hemostasis for the patients with poor general condition, large, tumors and deeonipensated liver function,who have no chance of radical resection. TAE followed by elective hepateetomy is considered an effective strategy for patients with ruptured HCC.