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
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。
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.
Hepatocellular carcinoma (HCC) / Spontaneous rupture / Hepatectomy
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广东省医学科研基金项目（A2011172）
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