肝癌破裂出血围手术期死亡危险因素分析

doi:10.13418/j.issn.1001-165x.2014.05.025

中国临床解剖学杂志 ›› 2014, Vol. 32 ›› Issue (5): 616-619.doi: 10.13418/j.issn.1001-165x.2014.05.025

肝癌破裂出血围手术期死亡危险因素分析

林浩铭¹，　朱颉²，　李国林¹，　闵军¹

中山大学孙逸仙纪念医院　1.肝胆外科，　2.急诊外科，广州 510236

收稿日期:2014-07-25 出版日期:2014-09-25 发布日期:2014-10-14
通讯作者: 闵军，主任医师??肝胆外科教授, 博士生导师, Tel：（020）34071165
作者简介:林浩铭(1973-),医学博士，讲师，主要从事肝胆外科临床工作,Tel：（020）34071165
基金资助:
广东省医学科研基金项目（A2011172）

Risk factors analysis of perioperative mortality in ruptured bleeding of hepatocellular carcinoma

LIN Hao-ming, ZHU Jie, LI Guo-lin, MIN Jun

Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510236, China

Received:2014-07-25 Online:2014-09-25 Published:2014-10-14

摘要/Abstract

摘要：

目的　探讨原发性肝细胞肝癌破裂出血急诊治疗的策略及其预后。方法　回顾分析60例肝癌破裂出血急诊治疗经验。治疗方法包括手术切除肿瘤，经肝动脉介入栓塞(TAE)和非手术治疗。单因素和多因素分析研究影响本组患者30 d死亡率的风险因素。结果　全组患者30 d死亡率为28.3%（n=17），单因素分析显示Child C级肝功,休克,大量输血及肿瘤体积巨大是影响患者30 d死亡率的风险因素。多因素分析显示休克和大量输血是影响手术切除患者30 d死亡率的独立危险因素。对于TAE患者，较大的肿瘤体积是影响预后的危险因素。结论　肿瘤破裂出血是原发性肝癌的严重并发症，肝功能较差，病期较晚以及出血的严重程度是影响预后的关键因素。根治性切除以及TAE治疗在严格选择的病例中可获得较好的效果。

关键词: 肝癌, 自发性破裂, 肝切除

Abstract:

Objective　Rupture of hepatocellular carcinoma (HCC) is a catastrophic emergency with high mortality. The aim of this study is to determine the factors associated with the prognosis and to assess the outcome of different management strategies.　Methods　Clinical and biochemical factors of 60 consecutive patients with rupture of HCC from 2005 to 2013 were studied. Univariate logistic regression analysis was performed to determine the relative factors leading to 30-day motality. Significant factors then entered into a multivariate logistic regression to determine independent factors associated with 30-day motality.　Results　In our study, 30-day mortality rate was 28.3% (n=17). Child’s C status, shock on admission, higher blood transfusion requirement and larger tumor size were with statistical significance on univariate analysis. On multivariate analysis, only shock on admission (P=0.001) and higher blood transfusion requirement (P=0.01) were significant independent factors affecting early post-operative mortality. A larger tumor size was identified as an independent factor related to post- TAE mortality. Curative resection was associated with a better 30-day survival as compared with conservative therapy or palliative operation.　Conclusions　Rupture of HCC is a salvageable complication of HCC. Poor prognosis is associated with poor liver reserve, advanced disease and severity of haemorrhage. Curative resection and TAE are better choices in selected patients.

Key words: Hepatocellular carcinoma (HCC), Spontaneous rupture, Hepatectomy

中图分类号:

R657.32

林浩铭, 朱颉, 李国林, 闵军. 肝癌破裂出血围手术期死亡危险因素分析[J]. 中国临床解剖学杂志, 2014, 32(5): 616-619.

LIN Gao-Ming, SHU Jia, LI Guo-Lin, MIN Jun. Risk factors analysis of perioperative mortality in ruptured bleeding of hepatocellular carcinoma[J]. Chinese Journal of Clinical Anatomy, 2014, 32(5): 616-619.

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肝癌破裂出血围手术期死亡危险因素分析

Risk factors analysis of perioperative mortality in ruptured bleeding of hepatocellular carcinoma

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