肝细胞癌破裂出血的治疗

Treatments for rupture and hemorrhage of hepatocellular carcinoma

目的探讨肝细胞癌(肝癌)破裂出血治疗方案的选择。方法回顾性分析2010年3月至2018年3月广东省佛山市第一人民医院收治的228例肝癌破裂出血患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男137例,女91例;年龄28~76岁,中位年龄47岁。按治疗方式不同,将患者分为保守治疗组(17例)、介入组(110例)、急诊切除组(36例)和联合介入切除组(联合组,65例)。介入组采用经导管肝动脉栓塞(TAE)和(或)TACE。观察各组疗效。止血率和生存率的比较采用Fisher确切概率法。结果保守治疗组止血率65%(11/17),1年生存率0。介入组止血率86%(95/110),1年生存率50%。急诊切除组止血率100%(36/36),1年生存率89%。介入联合切除组止血率达100%(65/65),1年生存率达84%。4组止血率及1年生存率比较差异有统计学意义(P<0.05)。结论肝癌破裂出血行急诊手术切除患者的近期及远期疗效最佳,应作为首选方案。若出血速度快,生命体征不平稳,则建议行介入后肝切除。对于肝功能较差,全身情况较差,病灶多发或较大无切除机会者,可选择介入治疗或保守治疗。

Objective To investigate the therapeutic plans for rupture and hemorrhage of hepatocellular carcinoma(HCC).Methods Clinical data of 228 patients with HCC-induced rupture and hemorrhage admitted to the First People's Hospital of Foshan from March 2010 to March 2018 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,137 patients were male and 91 female,aged 28-76 years old with a median age of 47 years old.According to different treatments,all patients were divided into the conservative therapy group(n=17),interventional therapy group(n=110),emergent resection group(n=36)and interventional therapy combined with resection(combining therapy)group(n=65).Transcatheter arterial embolization(TAE)and(or)transarterial chemoembolization(TACE)were employed in interventional therapy group.Clinical efficacy in each group was observed.The hemostasis rate and survival rate were compared by Fisher's exact probability test.Results In conservative therapy group,the hemostasis rate and the 1-year survival rate was 65%(11/17)and 0,respectively,while 86%(95/110)and 50%in interventional therapy group,and 100%(36/36),89%in emergent resection group,and 100%(65/65)and 84%in combining therapy group.The hemostasis rate and 1-year survival rate significantly differed among 4 groups(P<0.05).Conclusions Emergent surgery yields the optimal short-term and long-term clinical efficacy in the management of HCC-induced rupture and hemorrhage,which should be recommended as the primary therapy.Hepatectomy following interventional therapy is recommended for patients with severe bleeding and unstable vital signs.Interventional or conservative therapy can be chosen for those with poor liver function and general condition,multiple lesions or unresectable giant lesions.