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目的 探讨经肝动脉插管栓塞 (TAE)治疗原发性肝癌自发破裂出血的临床价值。方法42例原发性肝癌自发破裂出血患者 ,根据治疗方法的不同分为 4组 :A组 15例 ,TAE后择期部分肝切除 ;B组 11例 ,单纯TAE治疗 ;C组 6例 ,急诊手术治疗 ;D组 10例 ,内科保守治疗。结果 A、B两组2 6例患者治疗前腹腔动脉造影 ,有 7例可见造影剂外渗 (2 6 .9% ) ,其余为富血供肿瘤染色。A、B、C3组的止血成功率 (10 0 % )明显高于D组 (4 0 % ,P <0 .0 5 ) ,3组的住院死亡率分别为 0 ,3.8%和 16 .7%(P≥ 0 .2 86 ) ,明显低于D组的 80 .0 % (P <0 .0 1)。A组 1年存活率为 76 .3% ,明显高于B组 (4 7.5 % )和C组 (4 3.7% ,P <0 .0 5 )。D组未有生存超过 1年者 ,与前述 3组差异有极显著性 (P <0 .0 1)。结论TAE是原发性肝癌破裂急诊止血的有效、安全方法。对可切除的肝癌患者 ,TAE后择期手术切除应作为首选治疗方案。
Objective To investigate the clinical value of transcatheter arterial embolization (TAE) in the treatment of spontaneous rupture of primary liver cancer. Methods Forty-two patients with spontaneous rupture of primary hepatocellular carcinoma were divided into 4 groups according to the different treatment methods: 15 cases in group A, partial elective liver resection after TAE, 11 cases in group B, TAE alone, 6 cases in group C, emergency operation Treatment; Group D 10 cases, conservative treatment. Results A total of 26 patients in group A and group B had preoperative celiac angiography, 7 cases showed extravasation of contrast agent (26.9%), and the rest were rich blood for tumor staining. The success rate of hemostasis (100%) in group A, B and C3 was significantly higher than that in group D (40%, P <0.05). The in-hospital mortality in group A was 0, 3.8% and 16.7% (P≥0.286), which was significantly lower than 80.0% in group D (P <0.01). The 1-year survival rate in group A was 76.3%, significantly higher than that in group B (4.75%) and group C (3.7%, P <0.05). Patients in group D who did not survive for more than 1 year had significant difference from the previous three groups (P <0.01). Conclusion TAE is an effective and safe method for hemostasis in patients with primary liver cancer rupture. For resectable patients with liver cancer, TAE after elective surgical resection should be used as the preferred treatment.