Abstract: 【Abstract】 Objective〓To explore the management of patients with spontaneous rupture of hepatocellular carcinoma. Methods〓105 patients with spontaneously ruptured hepatocellular carcinoma between Jan. 1992 and Dec. 2013 in the Jiangmen People’s Hospital were enrolled in this retrospective review of clinical data. The first stage was from 1992 to 2002 (47 patients) and the second stage was from 2003 to 2013.(58 patients)..The patients underwent conservative treatment or emergency hepatectomy in first stage. And in second stage, conservative treatment, emergency hepatectomy and transcatheter arterial embolization was used..30-day survival rate,.1 year survival rate and the cumulative survival rate were contrasted in two stages. Results〓In first stage,.22 of 47 patients underwent conservative treatment,.and another 25 cases were performed emergency hepatectomy. Twenty-two patients died in 30 days in the first stage. In second stage of 58 patients, 12 underwent conservative treatment,.and emergency hepatectomy in 29 cases.(10 of whom received staged hepatectomy),.transcatheter arterial embolization in 17 patients..Sixteen patients died in 30 days at second stage. In two stage, the cumulative survival rate was higher in patients underwent hepatectomy than that in other treatments.(P<0.05)..The cumulative survival rate in the second stage was higher than that in the first stage.(P=0.036)..There were no difference in the cumulative survival rate of patients who received hepatectomy between two stage.(P=0.234)..Conclusion〓In present data, conservative treatment for patients with spontaneous rupture of hepatocellular carcinoma showed a poor prognosis..Transcatheter arterial embolization displayed an effective emergency hemostatic measure. Emergency hepatectomy or staged hepatectomy prolonged survival time of right patients.

Key words: Hepatocellular carcinoma, Rupture, Hepatectomy, Transcatheter arterial embolization

摘要： 【摘要】 目的 探讨肝细胞性肝癌自发性破裂出血患者的治疗策略。方法〓对江门市人民医院两个不同历史阶段收治的肝癌破裂患者的临床资料进行回顾性对比研究,第一阶段(1992~2002年)肝癌破裂患者47例,采取手术或保守治疗;第二阶段(2003~2013年)肝癌破裂患者58例,采用手术、经肝动脉栓塞或保守治疗,对比两阶段患者的30天、1年生存率和累计生存率。结果〓第一阶段保守治疗22例,急诊肝切除25例,30天死亡22例;第二阶段12例保守治疗,急诊肝切除29例,经肝动脉栓塞17例,其中10例栓塞之后行肝切除手术,30天死亡例16例。两阶段中手术治疗患者较非手术治疗患者累积生存率高(P﹤0.05);第二阶段患者累积生存率较第一阶段高(P=0.036),两阶段中手术治疗患者的累积生存率比较无统计学差异(P=0.234)。结论 对于自发性肝癌破裂出血患者,保守治疗预后差,经肝动脉栓塞为有效的急诊止血措施,对合适的患者实施急诊或分期肝切除可延长患者生存时间。

关键词: 肝细胞性肝癌, 破裂, 肝切除术, 经肝动脉栓塞