- 期刊
自發性肝細胞癌破裂引起腹腔內出血之臨床分析
A Clinical Review of Hemoperitoneum Due to Spontaneous Rupture of Hepatocellular Carcinoma (HCC)
摘要
肝細胞癌在本省是常見的惡性腫瘤，其自發性破裂引起腹內出血的亦不罕見，其發生率在本省的報告約在10-20%間。本研究係就本院外科在過去六年內經歷的28例 (男23位，女5位)自發性肝癌破裂造成急性腹內出血病例，其診斷、治療及預後提出報告。 這此病人經腹部穿刺抽出腹腔內有不凝固血液後，經由超音波掃描確定為肝癌破裂引起腹腔內出血，即採取緊急處理。有五位病人接受輸血輸液等保守療法，三位在住院其間死亡，死亡率為60%，另外20位接受外科療法以求止血，其中開腹術局部止血的死亡率為27.3% (3/11)，肝腫瘤切除及肝動脈結紮的死亡率為20% (1/5)，近來本院對本症施行經導管肝動脈栓塞療法，獲得良好效果。 本症之死亡率甚高，其預後隨治療方法之不同而有差異，在確定診斷後，如屬非硬化性的結節狀肝癌可採用積極外科療法以切除腫瘤，如為瀰漫型或合併有肝硬化的肝癌可採用肝動脈栓塞療法以提高治療效果。
關鍵字
無資料並列摘要
One hundred and thirty-four patients of hepatocellular carcinoma in our surgical department were determined by histopathological study in the past 6 years since 1978. Spontaneous rupture of hepatocellular carcinoma was found in 28 patients, with an incidence of 20.9%. The peak of age incidence was in the fourth decade, and male cases were predominant. The gross appearances in those patients were nodular in 5 (17.86%), massive in 4 (14.29%), diffuse in 11 (39.28%) and unknown in 8 (28.57%). Five patients had received conservative treatment, and 3 died during admission. Surgical intervention was performed in 20 patients. The mortality rate of laparotomy with biopsy was 27.3% (3/11), and removing the tumor with hepatic artery ligation was 20.0% (1/5). Recently, we had performed transcatheter artery embolization to control the intra-abdominal bleeding due to rupture of the hepatocellular carcinoma, with excellent results. The mortality of this disease is extremely high, and the prognoses were varied, based on the choice of management. Treatment is aimed at controlling the hemorrhage and resecting the tumor mass of the liver as much as possible. We suggest that, before the treatment, the abdominal echo is a very effective and simple aid in making a decision on the method of management.