原发性肝细胞性肝癌自发破裂出血危险因素及不同治疗方法预后分析  

Risk factors and outcomes of different treatment for spontaneous rupture of hepatoceulllar carcinoma

作　　者：高伟[1] 李涛[1] 赵威[2] 王德胜[2] 

机构地区：[1]陕西省汉中市中心医院肝胆外科,陕西汉中723000 [2]第四军医大学西京医院肝胆外科,陕西西安710032

出　　处：《中国现代普通外科进展》2016年第7期527-530,共4页Chinese Journal of Current Advances in General Surgery

摘　　要：目的 ：探索原发性肝癌自发破裂出血的危险因素及不同治疗方法的预后。方法 ：选取2003年3月—2013年3月59例原发性肝癌自发破裂患者（病例组）,其中19例仅行急诊肝动脉栓塞术,23例行二期行肝切除术;选取同期未发生破裂的467例原发性肝癌患者作为对照组。回顾性分析原发性肝癌自发破裂出血患者的临床资料和不同治疗方法的预后。结果：多因素分析显示,肿瘤〉7 cm（H R 7.38,95%C I：1.91~28.58,P〈0.05）、肿瘤位于Ⅱ、Ⅲ、ⅣbⅥ段（H R 5.03,95%C I：2.70-6.37,P〈0.05）以及肝功能差（H R 6.04,95%C I：2.83~12.88,P〈0.05）是原发性肝癌自发破裂出血的独立危险因素。肝动脉栓塞术组止血成功率为92.8%,中位生存时间为12个月,1、3年总体生存率为43%、0%。二期肝切除术组中位生存时间为26个月,1、3年总体生存率为80%、19%。结论：肿瘤〉7 cm、Ⅱ、Ⅲ、ⅣbⅥ段及肝功能差是影响原发性肝癌自发破裂的重要危险因素。急诊肝动脉栓塞术止血成功率高,但二期肝切除术患者的术后生存时间较长;对于合适的病例,原发性肝癌破裂出血者应行二期肝切除术。Objective： To investigate the risk factors of spontaneous rupture of hepatocellular carcinoma,and to evaluate the protocol of different therapeutic strategy. Methods： From march 2003 march to 2013. 59 patients suffered from spontaneous ruptured of HCC included into this study. A control group of 467 patients with nonruptured HCC was selected. Clinical data were col- lected and outcomes of different treatment methods for ruptured HCC were evaluated and com- pared. Results- On multivariate analysis,Tumor size〉7 cm（HR 7.38, 95%CI： 1.91 - 28.58, P〈0.05）, tumor location in segments Ⅱ, Ⅲ, Ⅳ b ,Ⅵ （HR 5.03,95% C1：2.70 ~ 6.37,P〈0.05）and a poor liver functional reserve （HR 6.04,95% CI： 2.83 N 12.88, P〈0.05）were predictive factors of spontaneous rupture of HCC. In the study group, the Hemostasis success rate was 92.8%,the median survival were 26 months,the 1-, 3-year overall survival rates were 80% and 19% in the hepatic resection group which were significantly higher than those in the TAE group （12 months, 43%, and 0. respec- tively, P=0.001）. Conclusion： Tumor size〉7 cm, tumor location and a poor liver functional re- serve were associated with spontaneous rupture of HCC. Staged hepatectomy after TAE is a rational treatment for patients with ruptured HCC. Although. TAE is highly effective for initial hemostasis, hepatectomy appears to provide better long-term survival, so staged hepatic resection should be recommended to the selected patients with ruptured HCC.

关 键 词：肝细胞癌 肿瘤破裂 危险因素 肝切除术 肝动脉栓塞术 预后 

分 类 号：R735.7[医药卫生—肿瘤]