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目的探讨急诊肝切除治疗原发性肝癌(PLC)自发性破裂的安全性和可行性。方法回顾性分析本院1995年1月至2002年12月肝切除治疗24例PLC自发性破裂患者的临床资料,比较急诊肝切除组(A组,n=14)和延期肝切除组(B组,n=10)的手术并发症发生率、围手术期病死率、中位生存期和1、3年生存率。结果A、B两组手术并发症发生率分别为35·7%和20·0%(P=0·653),围手术期病死率分别为7·1%和10·0%(P=1·000),中位生存期分别为18·0个月(CI7·0个月,29·0个月)和18·0个月(CI13·4个月,22·7个月),1年、3年生存率分别为78·6%、34·3%和70·0%、40·0%(P=0·588),差异均无统计学意义。结论只要严格掌握手术适应征,急诊肝切除治疗PLC自发性破裂是安全可行的,可作为治疗的优先选择。
Objective To investigate the safety and feasibility of emergency hepatectomy in the treatment of spontaneous rupture of primary hepatocellular carcinoma (PLC). Methods The clinical data of 24 patients with PLC spontaneous rupture treated by hepatectomy from January 1995 to December 2002 in our hospital were retrospectively analyzed. Comparing the results of emergency resection group (A group, n = 14) and deferred liver resection group (B group) , n = 10), the perioperative mortality, median survival and 1, 3 year survival rate. Results The incidences of complications in group A and group B were 35.7% and 20.0% (P = 0.653), respectively. The perioperative mortality rates were 7.1% and 10.0% (P = · 000). The median survival time was 18.0 months (CI 7.0 · 29.0 months) and 18.0 months (CI 13 · 4 months, 22.7 months) The 3-year survival rates were 78.6%, 34.3% and 70.0%, 40.0% respectively (P = 0. 588), with no significant difference. Conclusion As long as strict indications of surgical indications are available, emergency hepatectomy for PLC spontaneous rupture is safe and feasible, which may be considered as a priority for treatment.