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本文对172例肝细胞癌(HCC)自发性破裂的日本患者作了复习。从1935～1987年间共172例患者,男146例(85%),女26例(15%),年龄21～84(平均55)岁。在资料齐全的119例患者中,79例(66%)有突发性上腹或右季肋下痛,腹胀19例(16%),休克症状8例(7%)。94例开始检查时有出血性休克58例(62%),91例作腹腔穿刺阳性者78例(86%),84例患者中有肝硬化65例(77%)。HCC 肉眼分型为结节型91例,巨块型40例;破裂部位为右叶76例(66%),左叶39例(34%);HCC 中85%合并肝硬化,33%有重度饮酒史。腹部体检后作腹腔穿刺对诊断有助,术前诊断率低,常被误诊为消化道穿孔、急性胰腺炎、胆囊穿孔或胃肠道出血而延误治疗。
This article reviews 172 Japanese patients with spontaneous rupture of hepatocellular carcinoma (HCC). From 1935 to 1987 a total of 172 patients, 146 males (85%), 26 females (15%), aged 21 to 84 (average 55 years). Among the 119 patients with complete data, 79 (66%) had sudden upper or right quarteral pain, 19 (16%) abdominal distension and 8 (7%) shock symptoms. Of the 94 patients, 58 (62%) had hemorrhagic shock at the beginning of the test, 78 (86%) had 91 patients with positive abdominal paracentesis, and 65 (77%) had cirrhosis among 84 patients. HCC was classified as nodular type in 91 cases and bulky type in 40 cases. There were 76 cases (66%) of the right lobe and 39 cases (34%) of the left lobe in the fracture site. HCC had 85% with cirrhosis and 33% Drinking history. Abdominal abdominal examination after abdominal puncture to help diagnose the low preoperative diagnosis, often misdiagnosed as digestive tract perforation, acute pancreatitis, gallbladder perforation or gastrointestinal bleeding delay treatment.