原发性肝癌破裂出血42例临床诊治分析

Clinical analysis of the diagnosis and treatment of the bleeding caused by rupture of primary liver cancer

目的探讨原发性肝癌破裂出血的诊疗措施,为临床提供参考。方法对该院收治原发性肝癌破裂出血42例患者的临床资料,分析临床症状、病情诊断及治疗方法。结果保守治疗18例(42.86%),死亡2例,1例失血性休克,1例肝功能衰竭,其中2例保守治疗后手术治疗;手术治疗13例(30.95%),止血成功率为100%;行经肝动脉插管化学栓塞术(TACE)治疗11例(26.19%),1例再次出血至肝功能衰竭死亡。术后随访1年内复发再出血死亡7例,生存1年以上35例。结论根据肝癌破裂出血患者的具体病情,一般应先予保守治疗,再行剖腹术或者肝动脉栓塞止血(TAE),能够有效止血,条件许可时可行肿瘤切除,对改善预后有一定的价值。

Objective To investigate the diagnosis and treatment of the bleeding caused by the rupture of primary liver cancer and to provide the reference for the clinics. Methods The clinical data of 42 cases with the bleeding caused by rupture of primary liver cancer in our hospital were analyzed retrospectively. Results Eighteen cases received the conservative treatment（ 42. 86%）. 2 patients died,in whom one case got hemorrhagic shock and one case got liver failure. Two cases received surgery after the conservative treatment; 13 cases received surgery（ 30. 95%）,and the hepatic artery chemical embolization（ TAE） rate was 100%; 11 cases received the treatment of the（ 26. 19%）,in whom one case suffered from rebleeding and died of liver failure. Seven cases died of rebleeding and 35 cases survived after a follow-up of one year. Conclusion According to the patients conditions,the conservative treatment should be considered first,and then open surgery or hepatic arterial embolization（ TAE） is sometimes necessary to perform on the patients,which can effectively stop bleeding,and improve the prognosis.