急诊肝切除术及肝动脉栓塞治疗原发性肝癌自发性破裂  

Emergent hepatectomy and transcatheter arterial embolization for spontaneous rupture of primary hepatocellular carcinoma.

作　　者：王景毅[1] 梁金龙[1] 郝迪斯[1] 金政锡[1] 刘国津[1] 

机构地区：[1]黑龙江省医院普外科,哈尔滨150001

出　　处：《中国综合临床》2009年第11期1185-1187,共3页Clinical Medicine of China

摘　　要：目的探讨急诊肝切除及经肝动脉插管栓塞（TAE）治疗原发性肝癌自发破裂出血的适应证、方法和疗效。方法回顾性分析85例原发性肝癌自发性破裂出血不同治疗方法的临床资料。比较急诊TAE后择期部分肝切除组（A组30例）、急诊TAE治疗组（B组22例）、急诊肝切除治疗组（C组18例）、内科保守治疗组（D组15例）的止血成功率、手术并发症发生率、住院病死率和1、3年生存率。结果A、B2组52例治疗前腹腔动脉造影有14例可见造影剂外渗（26．9％），其余为富血供肿瘤染色。A、B、C3组的止血成功率为100％（30／30、22／22、18／18），明显高于D组40％（6／15）（P均〈0．05）。3组的住院病死率分别为0％（0／30）、3．8％（2／52）和16．7％（3／18），明显低于D组80．0％（12／15，P均〈0．01）。A组1年生存率为76．7％，3年生存率为53．3％，明显高于B组（45．5％、31．8％）、C组（44．4％、33．3％）（P均〈0．05）。D组无生存超过1年者，与前述3组形成强烈对照（P均〈0．01）。结论TAE和急诊肝部分切除术是原发性肝癌破裂急诊止血的有效、安全方法。对可切除病例，TAE后择期手术切除应作为首选治疗方案。Objective To evaluate the indications,method and prognosis of emergent hepatectomy and transcatheter arterial embolization（TAE） for spontaneous rupture of primary liver carcinoma（PLC）. Methods Clinical data of 85 cases with PLC were analyzed. Patients were divided into four groups ： the group of delayed hepatectomy （ group A, n = 30） ; the group of emergent transcatheter arterial embolization （ group B, n = 22 ） ; the group of emergent hepatectomy （ group C, n = 18 ） and the group of medical treatment （ group D, n = 15 ）. The hemostasis achievement ratio, operative complications, perioperative morbidity, 1-year and 3-year survival rates among the four groups were compared. Results In group A and B, celiac arteriogram in 52 cases showed that extravasation of contrast media happened in 14 cases （26.9%）. The hemostasis achievement ratio was 100% （30/30,22/22, 18/18 ） in group A, B and C, respectively,which was remarkably higher than that in group D （40% ,6/15 ） （P 〈 0.05 ） ;The inhospital fatality was 0% （0/30） ,3.8% （2/52） and 16.7% （3/18） ,which was lower than that of group D（80.0%, 12/15 ） （ P 〈 0.01 ）. The 1-year survival rate was 76.7% and 3-year survival rate of group A was 53.3%, which was higher than that of group B （45.5 % and 31.8 % ） and group C （44.4% and 33.3 % ） （ P 〈 0.05 ）. The cases in group D did not survive one year（ P 〈 0. 01 ）. Conclusions Emergent hepatectomy and transcatheter arterial embolization are safe and feasible for spontaneous rupture of primary hepatocellular carcinoma. For those with resectable cases, surgical resection is the first choice after transcatheter arterial embolization.

关 键 词：肝肿瘤 肝切除术 肝动脉栓塞 自发性破裂 

分 类 号：R735.7[医药卫生—肿瘤] R459.7[医药卫生—临床医学]