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目的:探讨急诊肝切除治疗原发性肝癌破裂出血的临床效果。方法:回顾性分析2005年1月―2014年12月间57例肝癌破裂出血患者行急诊肝切除手术的临床资料。结果:所有患者顺利实施急诊手术治疗,住院病死率为10.5%。其1、3、5年总体生存率与无瘤生存率分别为77.6%、51.0%、32.7%与69.4%、40.8%、18.4%,中位生存时间为38.7个月。获得随访的49例患者中38例出现复发转移,其中肝内复发18例(47.4%),肝外转移20例(52.6%)。多因素分析显示瘤体>10 cm(HR=2.43,P=0.031)和多发肿瘤结节(HR=0.46,P=0.028)是患者术后生存的独立影响因素。结论:经合理的选择,对可切除的肝癌破裂出血患者实施急诊肝切除手术治疗是挽救生命、获得良好远期疗效的一种治疗方式。
Objective: To investigate the clinical effect of emergency hepatectomy in the treatment of primary liver cancer with ruptured hemorrhage. Methods: A retrospective analysis of 57 cases of liver cancer patients with rupture of hemorrhage during January 2005 to December 2014 underwent emergency hepatectomy was performed. Results: All patients underwent emergency surgery successfully. The in-hospital mortality rate was 10.5%. The 1-year, 3-year and 5-year overall survival and tumor-free survival were 77.6%, 51.0%, 32.7% and 69.4%, 40.8% and 18.4% respectively. The median survival time was 38.7 months. Among the 49 patients who were followed up, 38 cases showed recurrence and metastasis, among which 18 cases (47.4%) were intrahepatic recurrence and 20 cases (52.6%) were extrahepatic metastasis. Multivariate analysis showed that tumor size> 10 cm (HR = 2.43, P = 0.031) and multiple tumor nodules (HR = 0.46, P = 0.028) were independent prognostic factors for postoperative survival. Conclusion: With reasonable choice, it is a kind of treatment method to save lives and obtain good long-term curative effect for resectable patients with ruptured liver cancer who underwent emergency hepatectomy.