Abdel Samie A, Otto G, Theilmann L
Medizinische Klinik II, Klinikum Pforzheim, Akademisches Lehrkrankenhaus der Universität Heidelberg.
Z Gastroenterol. 2007 Jul;45(7):615-9. doi: 10.1055/s-2006-927404.
HCC rupture with potentially fatal haemoperitoneum is not an infrequent complication of primary hepaotcellular carcinoma with a prevalence between 2.9 and 26 % and must be considered in the differential diagnosis in all patients with acute haemoperitoneum. Spontaneous tumour rupture is the most common cause, although the pathogenesis of it is not completely understood. Because of the high mortality of an emergency tumour resection, it appears that a two-stage treatment approach with emergency TAE and subsequent elective hepatic resection is the safest and most effective strategy for the management of this life-threatening situation. Despite all therapeutic efforts, the prognosis of this severe complication still remains poor. We report on a 82-year-old patient with spontaneous tumour rupture as the first manifestation of liver cell carcinoma. Our patient represents an exception because his spontaneous HCC rupture occurred without concomitant liver cirrhosis. According to our knowledge this case report is the first publication on spontaneous HCC rupture without pre-existing liver cirrhosis.
肝细胞癌破裂伴潜在致命性腹腔积血是原发性肝细胞癌并不罕见的并发症，患病率在2.9%至26%之间，所有急性腹腔积血患者的鉴别诊断都必须考虑到这一点。自发性肿瘤破裂是最常见的原因，尽管其发病机制尚未完全明确。由于急诊肿瘤切除术死亡率高，对于这种危及生命的情况，两阶段治疗方法——急诊经动脉栓塞术（TAE）及随后的择期肝切除术——似乎是最安全、最有效的治疗策略。尽管采取了所有治疗措施，这种严重并发症的预后仍然很差。我们报告一例82岁患者，以自发性肿瘤破裂作为肝细胞癌的首发表现。我们的患者是个例外，因为他的自发性肝细胞癌破裂发生时并无肝硬化。据我们所知，本病例报告是首例关于无预先存在肝硬化的自发性肝细胞癌破裂的发表。
