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肝癌破裂出血形成肝內巨大血腫1例報道

原發性肝癌破裂出血的治療選擇

【摘要】　目的　總結原發性肝癌破裂出血治療的選擇原則。　方法　回顧分析2006年1月-2010年2月收治的 37例原發性肝癌破裂出血患者臨床資料。　結果　內科加介入止血效果好，肝葉切除術組術后徹底止血，無手術死亡病例。肝葉切除術9例中生存1年者7例，2年者5例，3年者3例；內科保守治療19例中生存1年者7例，最長生存16個月；介入治療組10例中生存1年者4例，2年者1例，無3年以上生存者。　結論　充分評估病情及選擇適當的治療方法對原發性肝癌破裂出血治療有重要意義。肝葉切除是治療原發性肝癌破裂出血的有效方法，可明顯延長生存期。介入治療并發癥少，急診肝動脈栓塞止血效果好，可通過血管造影判斷有無行根治性手術的可能，以減少不必要的急診手術探查。

Elective laparoscopic hepatectomy in the treatment of ruptured hepatocellular carcinoma

Objective To investigate the feasibility of elective laparoscopic hepatectomy in the treatment of ruptured hepatocellular carcinoma. Methods We tried to perform an elective laparoscopic hepatectomy for a middle-aged man who had a ruptured hepatocellular carcinoma without active hemorrhage. The data of this patient was summarized. Results The patient received the elective laparoscopic hepatectomy, and the liver lesions were completely removed. The operation was successful. Operative time was 300 min and intraoperative bleeding was 500 mL. Postoperative recovery of this patient was good and no complication occurred. The abdominal drainage tube was removed on 4 days after operation, and he discharged on 8 days after operation. The pathology confirmed that the hepatocellular carcinoma was moderately differentiated and ruptured. Conclusion Elective laparoscopic hepatectomy is safe and feasible in the treatment of ruptured hepatocellular carcinoma for specific patient, but this operation needs to be performed by experienced surgeons with laparoscopic skills.