急诊肝切除治疗原发性肝癌破裂的预后分析

Prognostic analysis of emergency hepatectomy for spontaneous rupture and hemorrhage of hepatocellular carcinoma

目的:探讨急诊肝切除治疗原发性肝癌破裂出血的临床效果。方法:回顾性分析2005年1月―2014年12月间57例肝癌破裂出血患者行急诊肝切除手术的临床资料。结果:所有患者顺利实施急诊手术治疗,住院病死率为10.5%。其1、3、5年总体生存率与无瘤生存率分别为77.6%、51.0%、32.7%与69.4%、40.8%、18.4%,中位生存时间为38.7个月。获得随访的49例患者中38例出现复发转移,其中肝内复发18例(47.4%),肝外转移20例(52.6%)。多因素分析显示瘤体>10 cm(HR=2.43,P=0.031)和多发肿瘤结节(HR=0.46,P=0.028)是患者术后生存的独立影响因素。结论:经合理的选择,对可切除的肝癌破裂出血患者实施急诊肝切除手术治疗是挽救生命、获得良好远期疗效的一种治疗方式。

Objective： To investigate the clinical efficacy of emergency hepatectomy in treatment of spontaneous rupture and hemorrhage ofhepatocellular carcinoma （HCC）. Methods： The clinical data of 57 patients with rupture and hemorrhage of HCC undergoing emergency hepatectomy from January 2005 to December 2014 were retrospectively analyzed. Results All patients underwent successful emergency hepatectomy, and the in-hospital mortality was 10.5%. The 1-, 3- and 5-year overall survival rate was 77.6%, 51.0% and 32.7% and disease-free survival rate was 69.4%, 40.8% and 18.4%, respectively, with the median survival time of 38.7 months. Of the 49 patients receiving follow- up, recurrence occurred in 38 cases, including intrahepatic recurrence in 18 cases （47.4%）, and extrahepatic metastasis in 20 cases （52.6%）. The multivariate analysis showed that tumor size larger than 10 cm （HR=2.43, P=0.031） and multiple lesions （HR=0.46, P=0.028） were independent factors of the patients. affecting the postoperative survival.Conclusion： After appropriate selection, emergency hepatectomy for resectable HCC with rupture and hemorrhage is a life-saving and long-term effective treatment.