目的:探讨原发性肝癌自发破裂出血的发生机制、临床特点及诊治原则。方法:对我院2000年-2006年收治的36例原发性肝癌自发破裂出血患者的临床资料,诊疗方法及随访结果进行回顾性分析。结果:全组36例,男28例,女8例。30例有肝炎病史,34例合并肝硬化,突发右上腹剧痛29例,休克6例,腹膜刺激征26例,腹腔穿刺、B超及CT的诊断率分别为:85%、76%、92%。其中32例行手术止血,成功率100%,术后2周内肝功能基本恢复正常。28例获得随访:其中10例术后10个月内复发死亡,16例生存1年以上。保守治疗4例,2例住院期间死于失血性休克,2例死于肝功能衰竭。结论:原发性肝癌自发破裂出血时急诊行剖腹手术止血可以有效止血并同时切除肿瘤,部分患者可以达到根治性切除,应作为首选治疗方法。 Objective: To investigate the pathogenesis, clinical features, diagnosis and treatment of spontaneous rupture of primary liver cancer. Methods: The clinical data, diagnosis and treatment of 36 patients with spontaneous rupture of hepatocellular carcinoma admitted from 2000 to 2006 in our hospital were analyzed retrospectively. Results: The whole group of 36 cases, 28 males and 8 females. Thirty patients had history of hepatitis, 34 patients with cirrhosis, 29 patients with sudden right upper quadrant pain, 6 patients with shock and 26 patients with peritoneal irritation. The diagnostic rates of abdominal puncture, B ultrasound and CT were 85%, 76% 92%. Among them 32 cases underwent surgery to stop bleeding, the success rate was 100%. The liver function returned to normal within 2 weeks after operation. Twenty-eight patients were followed up: 10 patients died of recurrence within 10 months after operation and 16 patients survived for more than 1 year. Conservative treatment in 4 cases, 2 died of hemorrhagic shock during hospitalization, 2 died of liver failure. Conclusion: The spontaneous rupture of primary hepatocellular carcinoma when hemorrhage emergency cesarean section to stop bleeding can effectively stop bleeding and remove the tumor, some patients can achieve radical resection should be used as the preferred method of treatment.