Lai Eric C H, Lau W Y
Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong.
Arch Surg. 2006 Feb;141(2):191-8. doi: 10.1001/archsurg.141.2.191.
To review the management of spontaneous ruptured hepatocellular carcinoma in the acute phase, the definitive treatment after hemostasis, and the prognosis.
A MEDLINE search was undertaken to identify articles in English from 1970 to 2004 using the key words "hepatocellular carcinoma," "spontaneous rupture," "therapeutic embolization," and "laparoscopy." Additional articles were identified by a manual search of the references from the key articles.
There were no exclusion criteria for published information on the topics.
All studies that contained material applicable to the topic were considered.
In the acute phase, transarterial embolization for hemostasis has a high success rate (53%-100%). It has a lower 30-day mortality rate than open surgical methods (0%-37% vs 28%-75%). For the definitive treatment, staged liver resection has a higher resection rate (21%-56% vs 13%-31%) and a lower in-hospital mortality rate (0%-9% vs 17%-100%) than 1-stage emergency liver resection. Staged liver resection has a good survival rate (1-year survival, 54.2%-100%; 3-year survival, 21.2%-48%; 5-year survival, 15%-21.2%).
Transarterial embolization is effective in controlling bleeding from ruptured hepatocellular carcinoma in the acute phase. The serum bilirubin level, shock on hospital admission, and prerupture disease state are important prognostic factors to predict survival in the acute phase. For definitive treatment, staged liver resection after attaining hemostasis is better than 1-stage emergency liver resection. Laparoscopy and laparoscopic ultrasonography may decrease unnecessary exploratory laparotomy, thus increasing the resection rate of previously ruptured hepatocellular carcinoma. Prolonged survival can be achieved in select patients with definitive treatment. It is still uncertain whether the long-term outcome of liver resection is the same for hepatocellular carcinoma with and without rupture when patients with the same tumor stage and liver functional state are compared.
回顾肝细胞癌自发性破裂急性期的处理、止血后的确定性治疗及预后情况。
通过MEDLINE检索1970年至2004年发表的英文文章，关键词为“肝细胞癌”“自发性破裂”“治疗性栓塞”及“腹腔镜检查”。通过手工检索关键文章的参考文献确定其他文章。
对已发表的关于这些主题的信息无排除标准。
纳入所有包含适用于该主题资料的研究。
在急性期，经动脉栓塞止血成功率高（53% - 100%）。其30天死亡率低于开放手术方法（0% - 37%对28% - 75%）。对于确定性治疗，分期肝切除比一期急诊肝切除的切除率更高（21% - 56%对13% - 31%），住院死亡率更低（0% - 9%对17% - 100%）。分期肝切除有良好的生存率（1年生存率，54.2% - 100%；3年生存率，21.2% - 48%；5年生存率，15% - 21.2%）。
经动脉栓塞在控制肝细胞癌破裂急性期出血方面有效。血清胆红素水平、入院时休克及破裂前疾病状态是预测急性期生存的重要预后因素。对于确定性治疗，止血后分期肝切除优于一期急诊肝切除。腹腔镜检查及腹腔镜超声检查可减少不必要的剖腹探查，从而提高既往破裂肝细胞癌的切除率。经确定性治疗，部分患者可实现长期生存。当比较相同肿瘤分期及肝功能状态的患者时，有破裂和无破裂的肝细胞癌肝切除的长期结局是否相同仍不确定。
