手术切除治疗原发性肝癌患者肝破裂出血的预后评价

Surgical resection of primary liver cancer prognosis of liver rupture

目的观察手术切除治疗对原发性肝癌肝破裂出血患者预后的影响。方法回顾性分析我院于2009年1月-2012年6月收治的行手术治疗的原发性肝癌肝破裂患者32例,其中,8例左外叶切除,6例左半肝切除,2例右半肝切除,2例不规则切除,6例缝合止血(术后行肝动脉插管化疗),4例缝合后结扎肝动脉,4例局部填塞或大网膜覆盖,术后开展随访,记录患者生存及治疗情况,随访截止时间2015年8月31日。结果 32例患者术后均未再次手术治疗,6例单纯缝合止血者中,3例于术后5-7天因再出血死亡,另外3例生存时间分别为87天、101天、119天;4例局部填塞或大网膜覆盖者的生存时间分别为95天、112天、157天、173天;4例缝合后结扎肝动脉者的生存时间分别为98天、147天、242天、267天;18例行手术切除者,最短生存183天,最长生存35个月,1、2、3年生存率分别为38.89%(7/18)、16.67%(3/18)、0%。结论手术切除是原发性肝癌肝破裂出血患者较为有效的治疗方式之一,但临床中应依据患者的病情、经济及治疗需求情况选择治疗。

Objective To observe the surgical resection of bleeding in patients with ruptured prognosis for primary liver cancer. Methods A retrospective analysis of our hospital in 2009,1 Month- June 2012 admitted to surgical treatment of primary liver cancer patients with liver rupture 32 cases,of which,eight cases left lateral lobectomy,6 cases of left hepatectomy,2 Example right liver resection,2 cases of irregular removal,six cases hemostasis( postoperative hepatic arterial chemotherapy),four cases of hepatic artery ligation suture,four cases of partial filling or covering the omentum,postoperative carry out follow-up,Record patient survival and treatment,follow-up deadline for August 31,2015. Results Patients were 32 cases of postoperative reoperation,six cases of simple suture to stop bleeding in three cases in 5-7 days after surgery due to bleeding death,the other three cases were survival time was87 days,101 days,119 days; four cases of partial filling or omentum covered the survival time was 95 days,respectively,112 days,157 days,173 days; four cases of hepatic artery ligation suture survival time was 98 days,147 days,242 days,respectively,267days; 18 underwent surgical resection,the shortest survival of 183 days,the longest survival of 35 months,1,2,3-year survival rates were 38. 89%( 7 /18),16. 67%( 3 /18),0%. Conclusion Surgical resection is one of the more effective treatment of bleeding in patients with primary liver cancer rupture manner,but should be based on the clinical condition of the patient,and treatment demand economic choice of treatment.