摘要
目的探讨肝癌破裂出血的临床特点、诊断和治疗方法及其疗效,为临床治疗提供参考。方法回顾性分析2003-01-01-2010-07-31东莞市人民医院外科收治的77例肝癌破裂出血患者临床资料,其中行急诊肝切除术28例(另有6例为介入止血后肝切除,1例保守治疗止血后肝切除),姑息性手术11例,经导管动脉内化疗栓塞术或栓塞术(transcatheter arterial chemoembolization or embolization,TACE or TAE)治疗23例,内科保守治疗15例。分别对各组患者的近期止血效果和生存时间进行统计和随访。结果 28例急诊肝切除患者中,共14例采用肝不规则切除(右肝11例,左肝3例),并发症和死亡率较低;2例急诊肝切除后死亡,其余26例抢救成功,再出血和肝衰竭发生率相对较低;1年生存率为78.8%,平均生存时间为(437.2±101.4)d;右半肝切除术后发生肝衰竭和死亡率较高。姑息性手术组11例患者中,7例患者止血成功,4例再次出血;1年生存率为18.2%,平均生存时间为(79.8±48.6)d。介入组23例患者中,21例成功止血,4例因肝功能衰竭死亡;其中6例患者介入止血后施行根治性肝切除康复出院;1年生存率为60.0%,平均生存时间为(289.5±92.7)d。内科保守治疗组15例患者中,仅有6例患者止血成功,死亡率为66.0%;1年生存率为15.4%,平均生存时间为(68.8±37.1)d。结论肝癌破裂出血常以突发性腹痛为首发症状,不规则性肝切除成功率高,治疗效果较好,是首选的治疗措施。对无法手术根治患者可采用TACE介入治疗,可有效延长生存期。姑息性手术治疗和单纯内科保守治疗效果差。
OBJECTIVE To investigate the clinical features of liver rupture and the diagnosis and treatment so as to provide references for clinical treatment. METHODS The clinical data of 77 cases of spontaneous rupture from 2003.1 to 2010.7 in our hospital were investigated with a retrospective analysis. Among them,28 cases were underwent emergen- cy hepatectomy （6 cases of liver resection were performed after bleeding control with interventional therapy; one case was resected under the bleeding control with conservative treatment） ; 11 cases were treated with palliative surgery; 23 cases underwent transcatheter arterial chemoembolization or embolization（TACE or TAE） ; 15 cases were treated by conserva- tive treatment. The patients were Sollowed up and the hemostasis results and survival time of patients in each group were analyzed. RESULTS In the 28 cases of emergency liver resection,there were 14 cases operated by irregular hepatectomy （11 cases of right hepatoma,3 cases of left）,and the complications and mortality were low. In the emergency liver resec- tion, 2 patients died after operation, and the remained 26 cases were successful rescued. The incidences of liver failure were low relatively. The average 1-year survival rate of patients was 78. 8%, and mean survival time was （437.2 ± 101.4） days. In the 11 patients of the palliative surgery group, 7 patients had hemostasis treatment and 4 of them occurred re- breeding. Its 1-year survival rate was 18.2% ,and the average survival time was （79.8 ± 48.6） days. In the 23 patients of the interventional therapy group, the bleeding was controlled in 21 patients successfully,4 cases of death due to liver failure. In the patients of intervention group,6 patients accepted hepatectomy after the control of bleeding by TACE. Its one-year survival rate was 60.0% ,and the average survival time was （289.5 ± 92.7） days. In the 15 patients of the con- servative treatment group,only 6 patients were hemostasis and the liver failure and mortality were 66.0%. Its 1-year sur- vival rate was 15.4% ,and the average survival time was （68.8 ± 37.1） days. CONCLUSIONS Most spontaneous rup- ture of the liver cancer are diagnosed by the first symptom of sudden abdominal pain. Irregular liver resection is recom mended as the first choice for the treatment. Intervention of TACE can be adopted to prolong survival period for the inoperable patients.
出处
《中华肿瘤防治杂志》
CAS
北大核心
2015年第5期363-367,共5页
Chinese Journal of Cancer Prevention and Treatment
基金
广东省科技计划(2011B020800001)
广东省医学科研基金(B2010324)
东莞市科技计划(2010105150009)
关键词
肝肿瘤
破裂出血
急腹症
不规则性肝切除
经皮肝动脉栓塞化疗
liver neoplasms
rupture and bleeding
acute abdomen
irregular hepatectomy
transcatheter arterialchemoembolization
