Shuto T, Hirohashi K, Kubo S, Tanaka H, Hamba H, Kubota D, Kinoshita H
Second Department of Surgery, Osaka City University Medical School, Japan.
Surgery. 1998 Jul;124(1):33-7.
Although transcatheter arterial embolization is advocated as initial therapy for ruptured hepatocellular carcinoma (HCC), hepatic resection is necessary for cure. The effectiveness of delayed hepatic resection for ruptured HCC was determined.
The records of 10 patients who underwent delayed hepatic resection for ruptured HCC were reviewed.
All patients were men, and the mean age was 63 years. For hemostasis, transcatheter arterial embolization was performed in three patients, whereas in the other patients bleeding stopped without special procedures. Mean interval from rupture to hepatic resection was 74 days. Liver function test results before hepatic resection were almost normal. Trisegmentectomy in one and bisegmentectomy in four patients were performed, whereas minor hepatic resection was performed for four extrahepatic HCCs. There were no operative or hospital deaths. Four patients had cirrhosis. The mean tumor diameter was 7.5 cm. Of seven patients with recurrence, two with dissemination had tumors that ruptured on the inferior aspect of the liver. The 1- and 3-year survival rates were 77% and 48%, respectively.
Because delayed hepatic resection for ruptured HCC was safe and compared similarly with that for other patients who underwent resection for HCC, it should be used. However, when HCC ruptures in an inferior location, recurrence of tumor as dissemination is likely.
尽管经导管动脉栓塞术被推荐为破裂肝细胞癌（HCC）的初始治疗方法，但肝切除对于治愈该病是必要的。本研究确定了延迟肝切除治疗破裂HCC的有效性。
回顾了10例行延迟肝切除治疗破裂HCC患者的病历。
所有患者均为男性，平均年龄63岁。为了止血，3例患者接受了经导管动脉栓塞术，而其他患者未经特殊处理出血即停止。从破裂到肝切除的平均间隔时间为74天。肝切除术前肝功能检查结果基本正常。1例患者行三段肝切除术，4例患者行二段肝切除术，4例肝外HCC患者行小范围肝切除术。无手术或医院死亡病例。4例患者有肝硬化。平均肿瘤直径为7.5 cm。7例复发患者中，2例发生肝内播散，肿瘤位于肝脏膈面。1年和3年生存率分别为77%和48%。
由于延迟肝切除治疗破裂HCC是安全的，且与其他接受HCC切除术的患者情况相似，因此应采用该方法。然而，当HCC在膈面破裂时，肿瘤可能会以肝内播散的形式复发。
