【摘要】：目的評(píng)價(jià)急診與延期肝切除手術(shù)治療可切除性原發(fā)性肝細(xì)胞癌(HCC)破裂出血的療效,并分析手術(shù)時(shí)機(jī)對(duì)肝癌術(shù)后腹腔轉(zhuǎn)移的影響。方法回顧性分析我院2011年8月至2016年1月收治的38例HCC破裂出血且行肝切除患者的臨床資料,將入院后24小時(shí)內(nèi)手術(shù)者歸為急診組,1周后手術(shù)者歸為延期組,比較兩組患者圍手術(shù)期情況、術(shù)后生存率、無(wú)瘤生存率及復(fù)發(fā)轉(zhuǎn)移率。結(jié)果急診組術(shù)中出血量及輸血量均多于延期組(均P0.05),住院期間死亡率差異無(wú)統(tǒng)計(jì)學(xué)意義(6%vs 0%,P0.05)。急診組及延期組患者術(shù)后中位生存時(shí)間分別為22.5個(gè)月和14.2個(gè)月。急診組術(shù)后半年、1年、3年總體生存率分別為88.2%、82.4%、30.3%,無(wú)瘤生存率分別為81.3%、54.7%、27.3%,1年生存率及半年無(wú)瘤生存率均高于延期組(均P0.05)。延期組術(shù)后腹腔轉(zhuǎn)移率高于急診組,但差異無(wú)統(tǒng)計(jì)學(xué)意義(38.1%vs 29.4%,P0.05)。單因素及多因素分析顯示腫瘤直徑≥10cm及AFP10000ug/L是肝癌破裂出血患者發(fā)生腹腔轉(zhuǎn)移的危險(xiǎn)因素。結(jié)論急診肝切除術(shù)后患者短期預(yù)后優(yōu)于延期組。延期肝切除不增加肝癌破裂出血患者腹腔種植轉(zhuǎn)移的發(fā)生率。腫瘤直徑≥10cm、AFP10000ug/L是肝癌破裂出血患者發(fā)生腹腔種植轉(zhuǎn)移的危險(xiǎn)因素。
[Abstract]:Objective to evaluate the efficacy of emergency and delayed hepatectomy in the treatment of ruptured hemorrhage in resectable primary hepatocellular carcinoma (HCC) and to analyze the influence of operative timing on postoperative peritoneal metastasis of HCC. Methods the clinical data of 38 patients with rupture and hemorrhage of HCC treated in our hospital from August 2011 to January 2016 were retrospectively analyzed. The patients who had been operated within 24 hours after admission were classified as the emergency group and the group with delayed operation after one week. The perioperative period, postoperative survival rate, tumor free survival rate and recurrence and metastasis rate were compared between the two groups. Results the amount of intraoperative bleeding and blood transfusion in emergency group was higher than that in delayed group (P0.05), and there was no significant difference in mortality during hospitalization (P0.05). The median survival time was 22.5 months in emergency group and 14.2 months in delayed group. In the emergency group, the overall survival rate for half a year, one year and three years after operation was 88.2or 82.4, respectively, and the tumor-free survival rate was 81.34.727.33.The 1-year survival rate and the half-year tumor-free survival rate were higher than those in the delay group (P0.05). The rate of abdominal metastasis in delayed group was higher than that in emergency group, but there was no significant difference (38.1%vs 29.4% P 0.05). Univariate and multivariate analysis showed that tumor diameter 鈮，

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