肝癌自发性破裂出血的诊断和治疗  

Diagnosis and treatment for spontaneous rupture and hemorrhage of primary liver cancer

作　　者：张同军[1] 薛栋[1,2] 王建强[1] 李梦宇[1] 夏修良[1] 巩本刚[1] 

机构地区：[1]滨州医学院附属滨州市人民医院肝胆外科,山东滨州256610 [2]山东大学齐鲁医院肝胆外科,山东济南250012

出　　处：《中国现代普通外科进展》2012年第3期196-199,共4页Chinese Journal of Current Advances in General Surgery

摘　　要：目的:探讨肝癌自发性破裂出血的诊治方法。方法:回顾性分析36例肝癌自发性破裂出血患者的临床资料。36例患者中,单纯保守治疗组9例,介入治疗组13例,手术治疗组14例,其中急诊行肝癌切除术8例,出血局部缝扎加肝动脉结扎4例,大网膜填塞缝扎2例。结果:保守治疗组术后再出血3例,其中2例死于肝功能衰竭;介入治疗组均彻底止血,围手术期无肝功能衰竭发生;外科手术组术后均彻底止血,1例死于肝功能衰竭。保守治疗组9例中,生存1年者3例,2年者1例,3年者1例;介入治疗组13例,生存1年者8例,2年者5例,3年者3例;外科手术组14例中,生存1年者9例,2年者7例,3年者3例。结论:手术及介入治疗均是治疗肝癌破裂出血的有效方法,介入治疗止血满意,术后并发症少,可作为不能行切除手术患者的首选治疗方法。应根据患者肝功能状态、肿瘤大小、肿瘤分期,制定个体化治疗方案,争取最佳疗效。Objective：To explore the diagnosis and treatment for spontaneous rupture and hemorrhage of primary Liver Cancer.Methods：Clinical data of thirty-six patients who suffered from spontaneous rupture and hemorrhage of liver cancer from January 1996 to February 2009 were collected and analyzed retrospectively.9 cases received conservative therapy,13 received interventional therapy.14 cases were stanched by surgical therapy,in which 8 cases underwent liver cancer resection,4 cases underwent bleeding transfixion and hepatic artery ligation and 2 cases underwent greater omentum stuff transfixion.Results：In the conservative group,3cases had re-bleeding and two of them died of hepatic failure.There were no recurrent hemorrhage and acute hepatic function failure after the treatment in the the interventional therapy group.In the operation group,the bleeding completely stopped after operation,but 1 case died of hepatic failure.In 9 cases of conservative group,the one-year,two-year and three-year survival were 3 cases,1 case and 1 case respectively.In 13 cases of interventional therapy,the one-year,two-year and three-year survival were 8 cases,5 cases and 3 cases,respectively.In the 14 cases of operation,there were 9 cases of one-year survival,7 cases of two-year survival and 3 cases of three-year survival.Conclusion：Surgical and interventional treatment were both effective for spontaneous rupture and hemorrhage of primary liver cancer.Interventional therapy can stop bleeding effectively with less complications and can prolong survival time,so it can be used as the first choice for patients who have no chance of radical resection.For the best result,the selection of therapeutic method must be individulitiation by the patients＇ condition,liver function and tumor stage.

关 键 词：原发性肝癌 自发性 破裂出血 介入治疗 

分 类 号：R735.7[医药卫生—肿瘤]