25例肝癌破裂出血患者的诊断与治疗
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摘要
目的总结肝癌破裂出血的诊断与治疗方法。方法肝癌破裂出血患者25例中,12例行急诊手术治疗,8例采用肝动脉栓塞治疗,5例采用输血、抗休克、止血药物和抗炎等保守治疗。分析肝癌破裂出血的诊断和治疗方法。结果 12例急诊手术患者,出血均得到有效控制,手术后继续给予抗休克、抗感染和保肝等治疗,除1例因肝衰竭死亡外,其余患者恢复良好,顺利出院。8例肝动脉栓塞患者中,2例在住院期间因栓塞术后复发肝癌破裂出血死亡。5例保守治疗患者中,4例死亡,1例患者肝癌破裂出血停止,患者生命体征平稳后出院。结论肝癌破裂出血的诊断主要依据病史、体征和辅助检查,治疗方法有肝切除手术、肝动脉栓塞和保守治疗,可根据患者的病情选择合适的治疗方法。
Objective To summarize the diagnosis and treatment of 25 patients with spontaneous rupture of hepatocellular carcinoma.Methods Of 25 patients with spontaneous rupture of hepatocellular carcinoma,12 patients were treated by emergency operation(group S),8 patients received hepatoarterial embolization(group E) and 5 patients received conservative therapy including blood transfusion,anti-shock,hemostatic drugs and anti-inflammatory therapy(group C).ResultsHemostasis of group S was all successful and subsequent treatment included anti-shock,anti-infection and liver protection,of whom one patient died of hepatic failure after operation and the others were recovered well and discharged.Of 8 patients of group E,two patients died of re-rupture of hepatocellular carcinoma during hospital stay.Of 5 cases of group C,4 cases died and bleeding of one case stopped and discharged thenafter.Conclusion Diagnosis of spontaneous rupture of hepatocellular carcinoma depends mainly on medical history,clinical symptoms,physical signs and assistant examinations.The treatment includes surgical hemostasis,ransarterial embolization and conservative therapy,which is selected according to the illness status of the patients.
Objective To summarize the diagnosis and treatment of 25 patients with spontaneous rupture of hepatocellular carcinoma.Methods Of 25 patients with spontaneous rupture of hepatocellular carcinoma,12 patients were treated by emergency operation(group S),8 patients received hepatoarterial embolization(group E) and 5 patients received conservative therapy including blood transfusion,anti-shock,hemostatic drugs and anti-inflammatory therapy(group C).ResultsHemostasis of group S was all successful and subsequent treatment included anti-shock,anti-infection and liver protection,of whom one patient died of hepatic failure after operation and the others were recovered well and discharged.Of 8 patients of group E,two patients died of re-rupture of hepatocellular carcinoma during hospital stay.Of 5 cases of group C,4 cases died and bleeding of one case stopped and discharged thenafter.Conclusion Diagnosis of spontaneous rupture of hepatocellular carcinoma depends mainly on medical history,clinical symptoms,physical signs and assistant examinations.The treatment includes surgical hemostasis,ransarterial embolization and conservative therapy,which is selected according to the illness status of the patients.
引文
[1] 齐浩龙,钱崇崴,肖玉沙,等.肝细胞肝癌自发破裂出血的诊治与研究进展[J].腹部外科,2015,28(5):371-374.
[2] 游梦星,虞希祥,吴宽,等.原发性肝癌自发性破裂出血的危险因素分析[J].中华肿瘤杂志,2013,35(3):217-220.
[3] Aoki T,Kokudo N,Matsuyama Y,et al.Prognostic impact of spontaneous tumor rupture in patients with hepatocellular carcinoma:an analysis of 1160 cases from a nationwide survey[J].Ann Surg,2014,259(3):532-542.
[4] 董景辉,王华明, 张军华,等.原发性肝癌破裂出血的CT诊断及介入治疗[J].医学研究杂志,2010,39(1):103-105.
[5] 尚韬.四种治疗方法对肝癌破裂出血患者近期止血效果及生存时间的影响[J].浙江中西医结合杂志,2018,28(2):133-134.
[6] 徐克育,黄约翰,陶崇林,等.手术切除与肝动脉介入栓塞化疗治疗原发性肝癌破裂出血比较及预后分析[J].肝胆胰外科杂志,2014,26(1):9-11,19.
[7] 李爱军, 周伟平, 杨晓宇,等.原发性肝癌结节破裂出血的处理[J].上海医学,2011,34(9):653-655.
[8] 刘文斌,荚卫东.原发性肝癌破裂出血外科治疗技巧[J].国际外科学杂志,2013,40(10):716-718.
[9] Miyoshi A,Kitahara K,Kohya N,et al.Outcomes of patients with spontaneous rupture of hepatocellular carcinoma[J].Hepatogastroenterology,2011,58(105):99-102
[10] 张海龙.原发性肝癌破裂出血的介入治疗疗效分析[J]. 心理医生,2018,24(24):53-54.
[11] 张贵军,吴胜东,孙勤学,等.TACE后二期手术治疗小肝癌破裂出血的临床研究[J] .肝胆胰外科杂志,2014,26(3):188-191.
[12] Kirikoshi H,Saito S,Yoneda M ,et al.Outcomes and factors influencing survival in cirrhotic cases with spontaneous rupture of hepatocellular carcinoma: a multicenter study[J]. BMC Gastroenterol,2009,9:29.
[2] 游梦星,虞希祥,吴宽,等.原发性肝癌自发性破裂出血的危险因素分析[J].中华肿瘤杂志,2013,35(3):217-220.
[3] Aoki T,Kokudo N,Matsuyama Y,et al.Prognostic impact of spontaneous tumor rupture in patients with hepatocellular carcinoma:an analysis of 1160 cases from a nationwide survey[J].Ann Surg,2014,259(3):532-542.
[4] 董景辉,王华明, 张军华,等.原发性肝癌破裂出血的CT诊断及介入治疗[J].医学研究杂志,2010,39(1):103-105.
[5] 尚韬.四种治疗方法对肝癌破裂出血患者近期止血效果及生存时间的影响[J].浙江中西医结合杂志,2018,28(2):133-134.
[6] 徐克育,黄约翰,陶崇林,等.手术切除与肝动脉介入栓塞化疗治疗原发性肝癌破裂出血比较及预后分析[J].肝胆胰外科杂志,2014,26(1):9-11,19.
[7] 李爱军, 周伟平, 杨晓宇,等.原发性肝癌结节破裂出血的处理[J].上海医学,2011,34(9):653-655.
[8] 刘文斌,荚卫东.原发性肝癌破裂出血外科治疗技巧[J].国际外科学杂志,2013,40(10):716-718.
[9] Miyoshi A,Kitahara K,Kohya N,et al.Outcomes of patients with spontaneous rupture of hepatocellular carcinoma[J].Hepatogastroenterology,2011,58(105):99-102
[10] 张海龙.原发性肝癌破裂出血的介入治疗疗效分析[J]. 心理医生,2018,24(24):53-54.
[11] 张贵军,吴胜东,孙勤学,等.TACE后二期手术治疗小肝癌破裂出血的临床研究[J] .肝胆胰外科杂志,2014,26(3):188-191.
[12] Kirikoshi H,Saito S,Yoneda M ,et al.Outcomes and factors influencing survival in cirrhotic cases with spontaneous rupture of hepatocellular carcinoma: a multicenter study[J]. BMC Gastroenterol,2009,9:29.