CAJ | 학술논문

目的：总结原发性肝癌经导管动脉内化疗栓塞（TACE）术后发生肝癌破裂出血的相关危险因素、诊疗方法及预后，以提高对该并发症的认识。方法对2007年9月-2013年9月间原发性肝癌行TACE治疗术后并发肝癌破裂出血的患者进行回顾性分析。结果共678例原发性肝癌患者进行1379次TACE术。其中，8例患者在TACE术后出现肝癌破裂出血，例数发生率为1.2%，例次发生率为0.6%。8例患者的肿瘤最大直径平均为（11.5±2.6）cm（7.6~15.9 cm），病灶均位于肝包膜边缘，多数突向表面生长，5例合并有门静脉高压；TACE术中平均碘油使用量为（14.9±4.5）ml（8~20 ml）。行急症肝动脉栓塞治疗（TAE）4例，行内科保守治疗4例，7例患者积极抢救后无效死亡，仅1例患者TAE止血成功后恢复出院。结论原发性肝癌TACE术后肝癌破裂出血虽较为少见，但其后果却极为严重；其发生可能与病变特征（如肿瘤巨大、位于肝脏边缘突向表面生长或合并门静脉高压）及介入栓塞方法（如注入碘油后未使用颗粒栓塞剂加强栓塞）等因素有关。
목적：총결원발성간암경도관동맥내화료전새（TACE）술후발생간암파렬출혈적상관위험인소、진료방법급예후，이제고대해병발증적인식。방법대2007년9월-2013년9월간원발성간암행TACE치료술후병발간암파렬출혈적환자진행회고성분석。결과공678례원발성간암환자진행1379차TACE술。기중，8례환자재TACE술후출현간암파렬출혈，례수발생솔위1.2%，례차발생솔위0.6%。8례환자적종류최대직경평균위（11.5±2.6）cm（7.6~15.9 cm），병조균위우간포막변연，다수돌향표면생장，5례합병유문정맥고압；TACE술중평균전유사용량위（14.9±4.5）ml（8~20 ml）。행급증간동맥전새치료（TAE）4례，행내과보수치료4례，7례환자적겁창구후무효사망，부1례환자TAE지혈성공후회복출원。결론원발성간암TACE술후간암파렬출혈수교위소견，단기후과각겁위엄중；기발생가능여병변특정（여종류거대、위우간장변연돌향표면생장혹합병문정맥고압）급개입전새방법（여주입전유후미사용과립전새제가강전새）등인소유관。
Objective To summarize the risk factors, the diagnostic and therapeutic approaches, and the outcomes of the ruptured primary hepatocellular carcinoma (PHC) occurred after transcatheter arterial chemoembolization (TACE) in order to make a further understanding of this complication. Methods The clinical data of 8 patients with ruptured PHC after TACE, who were encountered at the First Affiliated Hospital of Suzhou University during the period from Sep. 2007 to Sep. 2013, were retrospectively analyzed. Results A total of 1379 times of TACE were performed in 678 patients with PHC. Among the 678 patients, 8 developed rupture of PHC with bleeding after TACE. The overall incidence was 1.2%. The mean diameter of the tumors in the 8 patients was (11.5 ± 2.6) cm, ranging from 7.6 cm to 15.9 cm. All the lesions were located at the peripheral region close to the liver capsule, and most of them protruded outward. Five cases had coexisting portal hypertension. The average dosage of Lipiodol used in TACE was (14.9 ± 4.5) ml with a range of (8 - 20) ml. Of the 8 patients, emergency transcatheter embolization was carried out in 4 and medical management was employed in other 4. Seven patients died as all active emergency treatments failed. Only one patient, who had received emergency transcatheter embolization, survived the ruptured PHC. Conclusion Rupture of primary hepatocellular carcinoma after TACE is a rare, but very serious complication. Its occurrence may be related to lesion’s characteristics, such as large tumor size, superficial location and protrusion from the liver surface, etc. Besides, interventional management, e.g. without use of solid embolic material to enhance the embolization effect, may also be responsible for the rupture.