• 重慶醫(yī)科大學(xué)附屬第一醫(yī)院肝膽外科(重慶400016);

目的研究肝癌破裂出血的原因和急性期止血以及止血后Ⅱ期治療措施。方法對(duì)國(guó)內(nèi)、外相關(guān)文獻(xiàn)進(jìn)行綜述分析。結(jié)果肝癌破裂出血的病因目前仍不完全清楚，我國(guó)肝癌破裂出血與乙肝病毒感染導(dǎo)致抗原抗體復(fù)合物沉積于腫瘤小動(dòng)脈壁致其損傷繼而破裂出血關(guān)系密切。治療方法有保守治療、手術(shù)治療（肝葉切除、肝動(dòng)脈結(jié)扎術(shù)、縫扎填塞）、肝動(dòng)脈插管栓塞術(shù)、其他治療（無水乙醇瘤內(nèi)注射、射頻消融、生物免疫療法等）。結(jié)論肝動(dòng)脈插管栓塞術(shù)在肝癌破裂出血急性期止血效果良好，可作為Ⅱ期綜合治療的基礎(chǔ)。

引用本文： 張華,羅詩(shī)樵,吳忠均. 肝癌破裂出血的診斷和治療. 中國(guó)普外基礎(chǔ)與臨床雜志, 2011, 18(12): 1338-1343. doi: 復(fù)制

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2. Globocan 2008 (IARC). Liver cancer incidence and mortality worldwide in 2008 summary [EB/OL]. http://globocan.iarc.fr/factsheets/cancers/liver.asp.
3. Battula N, Madanur M, Priest O, et al. Spontaneous rupture of hepatocellular carcinoma: a Western experience [J]. Am J Surg, 2009, 197(2): 164167.
4. Miyamoto M, Sudo T, Kuyama T. Spontaneous rupture of hepatocellular carcinoma: a review of 172 Japanese cases [J]. Am J Gastroenterol, 1991, 86(1): 6771.
5. Tanaka A, Takeda R, Mukaihara S, et al. Treatment of ruptured hepatocellular carcinoma [J]. Int J Clin Oncol, 2001, 6(6): 291295.
6. Kew MC, Hodkinson J. Rupture of hepatocellular carcinoma as a result of blunt abdominal trauma [J]. Am J Gastroenterol, 1991, 86(8): 10831085.
7. Hermann RE, David TE. Spontaneous rupture of the liver caused by hepatomas [J]. Surgery, 1973, 74(5): 715719.
8. Nagasue N, Inokuchi K, Kobayashi M, et al. Hepatoportal arteriovenous fistula in primary carcinoma of the liver [J]. Surg Gynecol Obstet, 1977, 145(4): 504508.
9. Kanematsu M, Imaeda T, Yamawaki Y, et al. Rupture of hepatocellular carcinoma: predictive value of CT findings [J]. AJR Am J Roentgenol, 1992, 158(6): 12471250.
10. Zhu LX, Geng XP, Fan ST. Spontaneous rupture of hepatocellular carcinoma and vascular injury [J]. Arch Surg, 2001, 136(6): 682687.
11. Zhu LX, Liu Y, Fan ST. Ultrastructural study of the vascular endothelium of patients with spontaneous rupture of hepatocellular carcinoma [J]. Asian J Surg, 2002, 25(2): 157162.
12. Zhu LX, Meng XL, Fan ST. Elasticity of small artery in patient with spontaneous rupture of hepatocellular carcinoma [J]. Hepatol Res, 2004, 29(1): 1317.
13. 朱立新, 耿小平, 范上達(dá). 肝癌自發(fā)性破裂病因探討 [J]. 中華外科雜志, 2004, 42(17): 10361039.
14. 朱立新, 耿小平, 范上達(dá). 肝癌自發(fā)性破裂患者血管超微結(jié)構(gòu)研究 [J]. 中華外科雜志, 2006, 44(3): 161164.
15. 呂成超, 朱立新. 肝癌自發(fā)性破裂機(jī)理的研究進(jìn)展 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2006, 13(2): 181183.
16. 馬連峰. 原發(fā)性肝癌自發(fā)性破裂出血誤診分析 [J]. 河南腫瘤學(xué)雜志, 2003, 16(1): 3333.
17. Vergara V, Muratore A, Bouzari H, et al. Spontaneous rupture of hepatocelluar carcinoma: surgical resection and longterm survival [J]. Eur J Surg Oncol, 2000, 26(8): 770772.
18. Yeh CN, Lee WC, Jeng LB, et al. Spontaneous tumour rupture and prognosis in patients with hepatocellular carcinoma [J]. Br J Surg, 2002, 89(9): 11251129.
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20. Kung CT, Liu BM, Ng SH, et al. Transcatheter arterial embolization in the emergency department for hemodynamic instability due to ruptured hepatocellular carcinoma: analysis of 167 cases [J]. AJR Am J Roentgenol, 2008, 191(6): W231W239.
21. Lai EC, Lau WY. Spontaneous rupture of hepatocellular carcinoma: a systematic review [J]. Arch Surg, 2006, 141(2): 191198.
22. Kirikoshi H, Saito S, Yoneda M, et al. Outcomes and factors influencing survival in cirrhotic cases with spontaneous rupture of hepatocellular carcinoma: a multicenter study [J]. BMC Gastroenterol, 2009, 9: 29.
23. 朱光輝, 翁杰鋒, 溫敏杰. 急診手術(shù)治療原發(fā)性肝癌破裂出血的臨床分析 [J]. 實(shí)用醫(yī)學(xué)雜志, 2008, 24(19): 33893390.
24. 汪建成, 胡道予, 姚洪亮, 等. 原發(fā)性肝癌自發(fā)性破裂出血介入動(dòng)脈栓塞治療 [J]. 中國(guó)癌癥雜志, 2005, 15(3): 285287.
25. 辜斌, 李小松. 肝癌破裂出血的肝動(dòng)脈栓塞治療 [J]. 實(shí)用臨床醫(yī)學(xué), 2008, 9(10): 4143.
26. 曾俊仁, 向述天, 徐松, 等. 肝癌破裂出血介入栓塞治療療效分析 [J]. 當(dāng)代醫(yī)學(xué), 2009, 15(29): 572573.
27. 王旭. 肝動(dòng)脈化療栓塞術(shù)治療肝癌破裂出血的臨床價(jià)值 [J]. 中國(guó)現(xiàn)代普通外科進(jìn)展, 2008, 11(6): 546547.
28. 張貴德, 姜成文, 宋希江. 肝動(dòng)脈栓塞治療26例原發(fā)性肝癌自發(fā)性破裂出血 [J]. 中國(guó)腫瘤臨床, 2007, 34(14): 833834.
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30. 范永斌, 孫思敬. 原發(fā)性肝癌自發(fā)破裂出血的外科治療 [J]. 中國(guó)現(xiàn)代普通外科進(jìn)展, 2008, 11(5): 440441.
31. Caruso DM, Battistella FD, Owings JT, et al. Perihepatic packing of major liver injuries: complications and mortality [J]. Arch Surg, 1999, 134(9): 958962.
32. 田建明, 王飛, 葉華, 等. 肝癌的規(guī)則性、變異性供血及其臨床意義 [J]. 中華放射學(xué)雜志, 1994, 28(2): 9396.
33. 羅志強(qiáng), 汪家珠, 莊陽(yáng)輝, 等. 原發(fā)性肝癌自發(fā)破裂出血的手術(shù)治療(附28例報(bào)告) [J]. 中華肝膽外科雜志, 2005, 11(3): 205206.
34. 肖玉根, 楊清水. 手術(shù)治療肝癌破裂出血32例 [J]. 中國(guó)醫(yī)藥, 2006, 1(8): 476477.
35. 吳安任. 手術(shù)治療原發(fā)性肝癌并發(fā)破裂出血的生存分析 [J]. 醫(yī)學(xué)信息, 2009, 22(7): 12631265.
36. 韓國(guó)秀, 王剛. 原發(fā)性肝癌破裂出血18例手術(shù)治療體會(huì) [J]. 河南外科學(xué)雜志, 2009, 15(1): 60.
37. 尹修才, 董建偉, 李新成. 肝癌破裂出血21例外科處理體會(huì) [J]. 中國(guó)當(dāng)代醫(yī)藥, 2010, 17(1): 144.
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41. 姚少清. 原發(fā)性肝癌自發(fā)性破裂出血臨床觀察 [J]. 中華實(shí)用診斷與治療雜志, 2008, 22(12): 941942.
42. 陳凌巖, 王偉, 陳驥, 等. 原發(fā)性肝癌自發(fā)性破裂外科治療81例分析 [J]. 中華普外科手術(shù)學(xué)雜志(電子版), 2010, 4(2): 193195.
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  1. 1. 夏鋒. 肝癌的分子分型與肝癌的診治 [J]. 實(shí)用臨床醫(yī)藥雜志, 2010, 14(13): 12.
  2. 2. Globocan 2008 (IARC). Liver cancer incidence and mortality worldwide in 2008 summary [EB/OL]. http://globocan.iarc.fr/factsheets/cancers/liver.asp.
  3. 3. Battula N, Madanur M, Priest O, et al. Spontaneous rupture of hepatocellular carcinoma: a Western experience [J]. Am J Surg, 2009, 197(2): 164167.
  4. 4. Miyamoto M, Sudo T, Kuyama T. Spontaneous rupture of hepatocellular carcinoma: a review of 172 Japanese cases [J]. Am J Gastroenterol, 1991, 86(1): 6771.
  5. 5. Tanaka A, Takeda R, Mukaihara S, et al. Treatment of ruptured hepatocellular carcinoma [J]. Int J Clin Oncol, 2001, 6(6): 291295.
  6. 6. Kew MC, Hodkinson J. Rupture of hepatocellular carcinoma as a result of blunt abdominal trauma [J]. Am J Gastroenterol, 1991, 86(8): 10831085.
  7. 7. Hermann RE, David TE. Spontaneous rupture of the liver caused by hepatomas [J]. Surgery, 1973, 74(5): 715719.
  8. 8. Nagasue N, Inokuchi K, Kobayashi M, et al. Hepatoportal arteriovenous fistula in primary carcinoma of the liver [J]. Surg Gynecol Obstet, 1977, 145(4): 504508.
  9. 9. Kanematsu M, Imaeda T, Yamawaki Y, et al. Rupture of hepatocellular carcinoma: predictive value of CT findings [J]. AJR Am J Roentgenol, 1992, 158(6): 12471250.
  10. 10. Zhu LX, Geng XP, Fan ST. Spontaneous rupture of hepatocellular carcinoma and vascular injury [J]. Arch Surg, 2001, 136(6): 682687.
  11. 11. Zhu LX, Liu Y, Fan ST. Ultrastructural study of the vascular endothelium of patients with spontaneous rupture of hepatocellular carcinoma [J]. Asian J Surg, 2002, 25(2): 157162.
  12. 12. Zhu LX, Meng XL, Fan ST. Elasticity of small artery in patient with spontaneous rupture of hepatocellular carcinoma [J]. Hepatol Res, 2004, 29(1): 1317.
  13. 13. 朱立新, 耿小平, 范上達(dá). 肝癌自發(fā)性破裂病因探討 [J]. 中華外科雜志, 2004, 42(17): 10361039.
  14. 14. 朱立新, 耿小平, 范上達(dá). 肝癌自發(fā)性破裂患者血管超微結(jié)構(gòu)研究 [J]. 中華外科雜志, 2006, 44(3): 161164.
  15. 15. 呂成超, 朱立新. 肝癌自發(fā)性破裂機(jī)理的研究進(jìn)展 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2006, 13(2): 181183.
  16. 16. 馬連峰. 原發(fā)性肝癌自發(fā)性破裂出血誤診分析 [J]. 河南腫瘤學(xué)雜志, 2003, 16(1): 3333.
  17. 17. Vergara V, Muratore A, Bouzari H, et al. Spontaneous rupture of hepatocelluar carcinoma: surgical resection and longterm survival [J]. Eur J Surg Oncol, 2000, 26(8): 770772.
  18. 18. Yeh CN, Lee WC, Jeng LB, et al. Spontaneous tumour rupture and prognosis in patients with hepatocellular carcinoma [J]. Br J Surg, 2002, 89(9): 11251129.
  19. 19. Kim PT, Su JC, Buczkowski AK, et al. Computed tomography and angiographic interventional features of ruptured hepatocellular carcinoma: pictorial essay [J]. Can Assoc Radiol J, 2006, 57(3): 159168.
  20. 20. Kung CT, Liu BM, Ng SH, et al. Transcatheter arterial embolization in the emergency department for hemodynamic instability due to ruptured hepatocellular carcinoma: analysis of 167 cases [J]. AJR Am J Roentgenol, 2008, 191(6): W231W239.
  21. 21. Lai EC, Lau WY. Spontaneous rupture of hepatocellular carcinoma: a systematic review [J]. Arch Surg, 2006, 141(2): 191198.
  22. 22. Kirikoshi H, Saito S, Yoneda M, et al. Outcomes and factors influencing survival in cirrhotic cases with spontaneous rupture of hepatocellular carcinoma: a multicenter study [J]. BMC Gastroenterol, 2009, 9: 29.
  23. 23. 朱光輝, 翁杰鋒, 溫敏杰. 急診手術(shù)治療原發(fā)性肝癌破裂出血的臨床分析 [J]. 實(shí)用醫(yī)學(xué)雜志, 2008, 24(19): 33893390.
  24. 24. 汪建成, 胡道予, 姚洪亮, 等. 原發(fā)性肝癌自發(fā)性破裂出血介入動(dòng)脈栓塞治療 [J]. 中國(guó)癌癥雜志, 2005, 15(3): 285287.
  25. 25. 辜斌, 李小松. 肝癌破裂出血的肝動(dòng)脈栓塞治療 [J]. 實(shí)用臨床醫(yī)學(xué), 2008, 9(10): 4143.
  26. 26. 曾俊仁, 向述天, 徐松, 等. 肝癌破裂出血介入栓塞治療療效分析 [J]. 當(dāng)代醫(yī)學(xué), 2009, 15(29): 572573.
  27. 27. 王旭. 肝動(dòng)脈化療栓塞術(shù)治療肝癌破裂出血的臨床價(jià)值 [J]. 中國(guó)現(xiàn)代普通外科進(jìn)展, 2008, 11(6): 546547.
  28. 28. 張貴德, 姜成文, 宋希江. 肝動(dòng)脈栓塞治療26例原發(fā)性肝癌自發(fā)性破裂出血 [J]. 中國(guó)腫瘤臨床, 2007, 34(14): 833834.
  29. 29. 孟環(huán). 急診介入治療肝癌破裂出血 [J]. 臨床醫(yī)學(xué), 2008, 28(12): 8283.
  30. 30. 范永斌, 孫思敬. 原發(fā)性肝癌自發(fā)破裂出血的外科治療 [J]. 中國(guó)現(xiàn)代普通外科進(jìn)展, 2008, 11(5): 440441.
  31. 31. Caruso DM, Battistella FD, Owings JT, et al. Perihepatic packing of major liver injuries: complications and mortality [J]. Arch Surg, 1999, 134(9): 958962.
  32. 32. 田建明, 王飛, 葉華, 等. 肝癌的規(guī)則性、變異性供血及其臨床意義 [J]. 中華放射學(xué)雜志, 1994, 28(2): 9396.
  33. 33. 羅志強(qiáng), 汪家珠, 莊陽(yáng)輝, 等. 原發(fā)性肝癌自發(fā)破裂出血的手術(shù)治療(附28例報(bào)告) [J]. 中華肝膽外科雜志, 2005, 11(3): 205206.
  34. 34. 肖玉根, 楊清水. 手術(shù)治療肝癌破裂出血32例 [J]. 中國(guó)醫(yī)藥, 2006, 1(8): 476477.
  35. 35. 吳安任. 手術(shù)治療原發(fā)性肝癌并發(fā)破裂出血的生存分析 [J]. 醫(yī)學(xué)信息, 2009, 22(7): 12631265.
  36. 36. 韓國(guó)秀, 王剛. 原發(fā)性肝癌破裂出血18例手術(shù)治療體會(huì) [J]. 河南外科學(xué)雜志, 2009, 15(1): 60.
  37. 37. 尹修才, 董建偉, 李新成. 肝癌破裂出血21例外科處理體會(huì) [J]. 中國(guó)當(dāng)代醫(yī)藥, 2010, 17(1): 144.
  38. 38. 蔡海. 原發(fā)性肝癌自發(fā)性破裂出血的特點(diǎn)和治療分析 [J]. 肝膽外科雜志, 2007, 15(3): 186188.
  39. 39. 許建偉, 趙文娟. 原發(fā)性肝癌自發(fā)性破裂出血的臨床分析 [J]. 南京醫(yī)科大學(xué)學(xué)報(bào)(自然科學(xué)版), 2007, 27(11): 13391340.
  40. 40. 李志壯, 曲新國(guó), 宋秀玲. 原發(fā)性肝癌破裂出血的外科處理 [J]. 中國(guó)醫(yī)藥導(dǎo)報(bào), 2008, 5(19): 125.
  41. 41. 姚少清. 原發(fā)性肝癌自發(fā)性破裂出血臨床觀察 [J]. 中華實(shí)用診斷與治療雜志, 2008, 22(12): 941942.
  42. 42. 陳凌巖, 王偉, 陳驥, 等. 原發(fā)性肝癌自發(fā)性破裂外科治療81例分析 [J]. 中華普外科手術(shù)學(xué)雜志(電子版), 2010, 4(2): 193195.
  43. 43. Buczkowski AK, Kim PT, Ho SG, et al. Multidisciplinary management of ruptured hepatocellular carcinoma [J]. J Gastrointest Surg, 2006, 10(3): 379386.
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