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目的 :研究分析原发性肝癌自发性破裂出血的临床诊断、治疗与预后的关系。方法 :13例原发性肝癌自发性破裂出血的患者 ,均于入院后 2～ 12h于边抗休克治疗同时 ,进行手术探查 ,采取左外叶切除 3例 ,左半肝切 1例 ,右半肝切 1例 ,第 5段肝切 3例 ,右后叶切除 2例 ,第 8段肝切除 2例 ,肝癌破裂缝合 1例。结果 :术后 1h死亡于出血性休克 1例 ,余均痊愈出院 ;术后行TACE或靶向化疗 5例 ,合并腹腔化疗 4例。术后随访 11例 ,术后生存 <11.5个月 2例 ,12～ 18个月 3例 ,19～ 30个月 2例 ,31～ 42个月 3例 ,>4年者 1例。最终死亡原因为癌复发和转移、肝昏迷、上消化道出血和肝肾综合征。结论 :早期正确诊断、及时有效治疗和术后综合治疗 ,对提高原发性肝癌自发性破裂出血治愈率 ,降低死亡率和改善预后有重要意义。
Objective: To study the relationship between clinical diagnosis, treatment and prognosis of spontaneous hepatocellular carcinoma (HCC). Methods: 13 patients with spontaneous hepatocellular carcinoma of spontaneous hemorrhage underwent surgical exploration at the same time from 2 to 12 hours after admission. At the same time, surgical exploration was performed. Left lateral lobe resection was performed in 3 cases, left hepatectomy in 1 case, and right half. One patient underwent hepatectomy, 3 hepatectomy in segment 5, 2 in right posterior lobe, 2 in hepatectomy in segment 8, and 1 in hepatic carcinoma. Results: One case died of hemorrhagic shock at 1 hour after operation. Yu Jun was discharged from the hospital. Five patients were treated with TACE or targeted chemotherapy and four patients were treated with intraperitoneal chemotherapy. Follow-up was performed in 11 cases. Postoperative survival was <11.5 months in 2 cases, 12 to 18 months in 3 cases, 19 to 30 months in 2 cases, 31 to 42 months in 3 cases, and >4 years in 1 case. The ultimate cause of death was cancer recurrence and metastasis, hepatic coma, upper gastrointestinal bleeding, and hepatorenal syndrome. Conclusion : Early correct diagnosis, timely and effective treatment and postoperative comprehensive treatment are of great significance in improving the cure rate of spontaneous rupture of primary hepatic carcinoma, reducing mortality and improving prognosis.