CAJ | 학술논문

目的探讨急诊肝切除及经肝动脉插管栓塞(TAE)治疗原发性肝癌自发破裂出血的适应证、方法和疗效.方法回顾性分析85例原发性肝癌自发性破裂出血不同治疗方法的临床资料.比较急诊TAE后择期部分肝切除组(A组30例)、急诊TAE治疗组(B组22例)、急诊肝切除治疗组(C组18例)、内科保守治疗组(D组15例)的止血成功率、手术并发症发生率、住院病死率和1、3年生存率.结果 A、B 2组52例治疗前腹腔动脉造影有14例可见造影剂外渗(26.9%),其余为富血供肿瘤染色.A、B、C 3组的止血成功率为100%(30/30、22/22、18/18),明显高于D组40%(6/15)(P均<0.05).3组的住院病死率分别为0%(0/30)、3.8%(2/52)和16.7%(3/18),明显低于D组80.0%(12/15,P均<0.01).A组1年生存率为76.7%,3年生存率为53.3%,明显高于B组(45.5%、31.8%)、C组(44.4%、33.3%)(P均<0.05).D组无生存超过1年者,与前述3组形成强烈对照(P均<0.01).结论 TAE和急诊肝部分切除术是原发性肝癌破裂急诊止血的有效、安全方法.对可切除病例,TAE后择期手术切除应作为首选治疗方案.
목적 탐토급진간절제급경간동맥삽관전새(TAE)치료원발성간암자발파렬출혈적괄응증、방법화료효.방법 회고성분석85례원발성간암자발성파렬출혈불동치료방법적림상자료.비교급진TAE후택기부분간절제조(A조30례)、급진TAE치료조(B조22례)、급진간절제치료조(C조18례)、내과보수치료조(D조15례)적지혈성공솔、수술병발증발생솔、주원병사솔화1、3년생존솔.결과 A、B 2조52례치료전복강동맥조영유14례가견조영제외삼(26.9%),기여위부혈공종류염색.A、B、C 3조적지혈성공솔위100%(30/30、22/22、18/18),명현고우D조40%(6/15)(P균<0.05).3조적주원병사솔분별위0%(0/30)、3.8%(2/52)화16.7%(3/18),명현저우D조80.0%(12/15,P균<0.01).A조1년생존솔위76.7%,3년생존솔위53.3%,명현고우B조(45.5%、31.8%)、C조(44.4%、33.3%)(P균<0.05).D조무생존초과1년자,여전술3조형성강렬대조(P균<0.01).결론 TAE화급진간부분절제술시원발성간암파렬급진지혈적유효、안전방법.대가절제병례,TAE후택기수술절제응작위수선치료방안.
Objective To evaluate the indications,method and prognosis of emergent hepateetomy and tran-scatheter arterial embolization(TAE) for spontaneous rupture of primary liver carcinoma(PLC). Methods Clinical data of 85 cases with PLC were analyzed. Patients were divided into four groups: the group of delayed hepatectomy (group A,n=30);the group of emergent transcatheter arterial embolization (group B,n=22);the group of emer-gent hepatectomy (group C, n=18) and the group of medical treatment (group D, n=15). The hemostasis achieve-ment ratio, operative complications, perioperative morbidity, 1-year and 3-year survival rates among the four groups were compared. Results In group A and B, celiac urteriogram in 52 cases showed that extravasation of contrast media happened in 14 cases (26.9%). The hemostasis achievement ratio was 100% (30/30, 22/22, 18/18) in group A,B and C,respectively,which was remarkably higher than that in group D(40%,6/15) (P<0.05);The in-hospital fatality was 0% (0/30),3.8% (2/52) and 16.7% (3/18),which was lower than that of group D(80.0%, 12/15) (P<0.01). The 1-year survival rate was 76.7% and 3-year survival rate of group A was 53.3%, which was higher than that of group B (45.5 % and 31.8 %) and group C (44.4% and 33.3 %) (P<0.05). The cases in group D did not survive one year(P<0.01). Conclusions Emergent hepatectomy and transcatheter arterial emboli-zation are safe and feasible for spontaneous rupture of primary hepatocellular carcinoma. For those with resectable ca-ses,surgical resection is the first choice after transcatheter arterial embolization.