经导管肝动脉化疗栓塞联合手术切除治疗肝细胞癌破裂出血

摘要

目的 探讨经导管肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)联合手术切除治疗肝癌破裂出血的临床价值.方法 回顾性分析我院2008年1月至2011年12月收治的26例肝癌破裂出血患者的临床资料.其中经TACE治疗19例、手术切除7例,有8例TACE后再手术切除.结果 26例肝癌破裂出血患者中19例经TACE治疗后休克及时纠正,生命体征很快稳定,复查CT肿瘤缩小；其中8例TACE治疗1个月后行Ⅱ期肿瘤切除,AFP均下降或正常,疗效优良.7例Ⅰ期手术者1例术后死亡,4例发生腹腔肿瘤种植转移.结论 TACE可有效治疗肝癌破裂出血、减少不可切除病例的剖腹探查止血手术、提高肿瘤切除率.TACE联合手术切除可显著降低肿瘤腹腔种植转移率.%Objective To study the efficacy of transcatheter arterial chemoembolization (TACE) combined with surgical resection in the treatment of ruptured hepatocellular carcinoma (HCC).Methods The clinical data of 26 patients who presented with ruptured HCC to our hospital from January 2008 to December 2011 were retrospectively studied. These patients received TACE (n=19),surgical resection (n=7),and surgical resection after TACE (n=8).Results Shock in the 19 patients who received TACE was promptly corrected and the vital signs were stabilized.On subsequent CT,the tumors shrunk in size.Salvage liver resection was carried out in 8 patients 1 month after TACE.After treatment,AFP decreased or became normalized,thus the treatment results were good. A one-stage liver resection was carried out in 7 patients. One patient died after operation and peritoneal metastases occurred in 4 patients. Conclusions TACE stopped bleeding from ruptured HCC efficaciously,reduced the need for open exploration,and improved the rate of resection of HCC.TACE combined with surgical resection significantly lowered the rate of abdominal tumor metastases.