CAJ | 학술논문

目的：探讨肝癌破裂出血的治疗方法及疗效，并分析影响肝癌破裂出血患者术后生存的独立因素。方法回顾性分析56例肝癌破裂出血患者的临床和随访资料，其中保守治疗25例，根治性手术治疗18例，姑息性手术治疗8例，肝动脉栓塞（TAE）5例，比较各组的临床疗效。并以中位生存期（ MST）为切割点将根治性治疗组分成2组，对影响根治性手术预后的相关因素行单因素和多因素分析。结果根治性手术组6，12，36个月生存率及MST明显优于保守治疗组、姑息性手术治疗组及TAE组（ P均＜0．01）。 COX回归模型提示肿瘤直径＞7 cm、高功能状态（ PS）评分是影响根治性手术组患者预后的独立因素。结论急诊行根治性手术是治疗肝癌破裂出血的有效方法，其疗效优于保守治疗、姑息性手术治疗及TAE治疗。而肿瘤直径＞7 cm及高PS评分为术后独立的不良预后因素。
목적：탐토간암파렬출혈적치료방법급료효，병분석영향간암파렬출혈환자술후생존적독립인소。방법회고성분석56례간암파렬출혈환자적림상화수방자료，기중보수치료25례，근치성수술치료18례，고식성수술치료8례，간동맥전새（TAE）5례，비교각조적림상료효。병이중위생존기（ MST）위절할점장근치성치료조분성2조，대영향근치성수술예후적상관인소행단인소화다인소분석。결과근치성수술조6，12，36개월생존솔급MST명현우우보수치료조、고식성수술치료조급TAE조（ P균＜0．01）。 COX회귀모형제시종류직경＞7 cm、고공능상태（ PS）평분시영향근치성수술조환자예후적독립인소。결론급진행근치성수술시치료간암파렬출혈적유효방법，기료효우우보수치료、고식성수술치료급TAE치료。이종류직경＞7 cm급고PS평분위술후독립적불량예후인소。
Obej ctive It is to approach the methods and curative effect for spontaneous rupture of hepatocellular carcino -ma, and analyze the influencing factors on postoperative survival of patients with bleeding and rupture of hepatocellular carci -noma .Methods The clinical data of 56 patients with bleeding and ruptures of hepatocellular carcinoma were retrospective ana -lyzed, that include 25 cases with conservative treatment , 18 cases with radical surgery , 8 patients with Palliative surgery and 5 patients with transarterial embolization ( TAE) .The clinical curative effect was compared .The patients received radical sur-gery were divided into two group according to median survival time ( MST) , and the influencing factors on postoperative surviv-al were analyzed by single factor and Multiple factor analysis .Resutl s The 6-, 12-, 36-month survival rate and MST in the radical surgery group were markedly better than that in the conservative treatment group , palliative surgery group and TAE group (P<0.01).A multivariate analysis showed a maximum tumor size exceeding 7 cm and Performance Status (PS) were the independent risk factors for the prognosis of patient with radical surgery .Conclusion Emergency radical surgery is an ef-fective method for the treatment of spontaneous rupture of hepatocellular carcinoma , it is better than conservative treatment , palliative surgery and TAE .The maximum tumor size >7 cm and PS score are the independent factors of poor prognosis for radical surgery .