肿瘤自发破裂出血作为原发性肝癌的严重并发症之一,在急腹症病人中并不罕见。但是在住院病人行择期手术时进腹前发生肝癌破裂出血却未见报道。现将作者在近期救治的3例报道如下。 1 临床资料例1.病人男性,52岁。因20天前突发性肝区痛伴发热2天,明确诊断左外叶原发性肝癌后入院。拟于1994年9月9日在持续硬膜外麻醉加气管内插管吸入麻醉下行肿瘤切除术。硬膜外置管成功后即注入0.75%布比卡因15ml,随后完成气管内插管吸入麻醉(安氟醚)。在切开腹壁皮肤时发现麻醉机上显示血压为8/4kPa,当明确不是由于麻醉机和血压计故障所致后,即暂停手术寻找低血压原因,并给予循环复苏药、快速输液等,但血压仍未回升,且心率降至50次/分,出现二联律。中止手术后在移去全部无菌巾单时,无意中发现病人腹部较麻醉实施前明显膨隆,腹腔穿刺抽 Spontaneous rupture of the tumor is one of the serious complications of primary liver cancer, and it is not uncommon in patients with acute abdomen. However, there was no report of hemorrhage of liver cancer before admission in patients undergoing elective surgery. The three cases reported by the author in the near future are as follows. 1 Clinical data 1. Patient Male, 52 years old. Due to sudden liver area pain and fever for 2 days before 20 days, a diagnosis of left hepatic primary liver cancer was confirmed before admission. On September 9, 1994, we plan to continue the epidural anesthesia and intubate the inhalation anesthesia for tumor resection. After the success of the epidural catheter, 1.55% bupivacaine (15ml) was injected, followed by an endotracheal intubation anesthesia (enflurane). When the abdominal wall skin was opened, it was found that the blood pressure on the anesthesia machine was 8/4 kPa. When it was definitely not due to the malfunction of the anesthesia machine and the blood pressure monitor, the operation was suspended to find the cause of low blood pressure, and circulation resuscitation medicine and rapid infusion were given, but the blood pressure Has not recovered, and the heart rate has dropped to 50 beats/min. After the surgery was discontinued, when the entire sterile towel sheet was removed, the abdomen of the patient was inadvertently found to be bulging before the anesthesia was performed and the abdomen was punctured.