急诊手术治疗15例肝癌破裂出血的临床分析  

Surgical treatment to the hemorrhage of spontaneous rupture of hepatocellular carcinoma:an analysis of 15 cases

作　　者：徐小宏 牟一平[1] 陈其龙[1] 陈定伟[1] 徐晓武[1] 朱一平[1] 严加费[1] 

机构地区：[1]浙江大学医学院附属邵逸夫医院普外科,浙江杭州310016 [2]浙江省淳安县妇幼保健院

出　　处：《全科医学临床与教育》2010年第6期641-643,共3页Clinical Education of General Practice

摘　　要：目的探讨肝癌自发性破裂大出血的手术治疗方法。方法回顾分析15例肝癌自发性破裂大出血患者的病灶部位、手术方式、术后止血效果、术后并发症和死亡率以及住院时间。结果 15例肝癌自发性破裂患者中行半肝切除5例、肝叶切除1例、不规则肝叶切除4例、肝动脉结扎加大网膜及明胶海绵填塞缝合止血3例、纱条填塞止血并选择性右肝动脉结扎2例。止血成功率100%,术后并发症率33.33%(5/15),住院时间15～52d,平均(22.73±9.27)d,无术后死亡病例。14例术后随访,1例失访。术后生存时间3～68个月,平均(37.67±20.50)月,3例存活至今,分别为l0、16和68个月。1、3年生存率分别为71.44%(10/14)、35.71%(5/14)。结论肝癌自发性破裂大出血时病情凶险,应急诊手术进行止血;如患者病情允许,同时切除肿瘤、急诊行肝切除是安全可行的治疗措施。Objective To investigate surgical treatment to massive hemorrhage of spontaneous rupture of hepatocellular carcinoma.Methods Data were analyzed retrospectively in 15 liver cancer patients with spontaneous rupture,including lesion location,surgical methods,postoperative homeostasis effects,complications and mortality,and stay days.Results In 15 cases of spontaneous rupture of hepatocellular carcinoma,performed semi-hepatectomy in 5 cases,liver lobe resection in 1 case,irregular hepatectomy in 4 cases,hepatic artery ligation and sutured gelatin sponge filled and omentum to bleeding in 3 cases,gauze packing and selective right hepatic artery ligation in 2 cases.Surgical Results：The surgical homeostasis success rate was 100%;the incidence of postoperative complications was 33.3%（5/15）;stay days：19～52 d（mean 22.73±9.27 d）,no postoperative deaths.Follow-up results：14 cases followed up,1 patient was lost.Survival time was from 3 to 68 months（mean 37.67±20.50 months）,3 patients survived l0,16 and 68 months.1,3-year survival rates were 71.44%（10/14） and 35.71%（5/14）.Conclusions Emergency surgery can effectively stop bleeding of the spontaneous rupture of hepatocellular carcinoma and also remove the tumor when the condition permits.Emergency treatment of liver resection is safe and feasible.

关 键 词：肝肿瘤 破裂 出血 肝切除术 

分 类 号：R735.7[医药卫生—肿瘤]