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目的探讨原发性肝癌(PLC)经导管肝动脉化疗栓塞(TACE)后破裂出血的危险因素及干预对策。方法回顾性分析2008年11月至2012年3月间行TACE治疗后1周内发生肝癌破裂出血患者的临床资料。结果 1428例原发性肝癌患者行TACE治疗后,1周内发生肝癌破裂出血患者为7例,破裂出血发生于术后13～72h,7例均给予保守治疗,7例患者肿瘤均具有位于肝脏表面、最大直径>5 cm和向外突出的特点,1例合并有明显的肝动脉-门静脉瘘。所有患者均出现不同程度的腹胀腹痛、血液流变学改变和血红蛋白下降。结论肿瘤破裂出血是原发性肝癌行TACE治疗后严重但发病率很低的并发症。肿瘤最大直径>5 cm、向外突出或邻近肝包膜下是其发生的危险因素。早期发现并积极治疗是改善预后的关键。
Objective To investigate the risk factors of ruptured hemorrhage after transcatheter arterial chemoembolization (TACE) in primary hepatocellular carcinoma (PLC) and its intervention strategy. Methods The clinical data of patients with hepatocellular carcinoma (HCC) hemorrhage within 1 week after TACE treatment between November 2008 and March 2012 were retrospectively analyzed. Results 1428 cases of primary liver cancer patients undergoing TACE treatment within 1 week occurred in patients with liver cancer rupture bleeding in 7 cases, rupture occurred in 13 ~ 72h after surgery, 7 cases were given conservative treatment, 7 patients with tumors located in the liver Surface, the largest diameter> 5 cm and outwardly prominent features, 1 case merged with obvious hepatic artery - portal vein fistula. All patients had varying degrees of bloating abdominal pain, hemorheological changes and hemoglobin decreased. Conclusions Tumor rupture and hemorrhage is a serious but low complication of TCC after primary hepatocellular carcinoma. The maximum tumor diameter> 5 cm, protruding out of or adjacent to the liver capsule is a risk factor for its occurrence. Early detection and aggressive treatment are the keys to improving prognosis.