• 重慶醫(yī)科大學附屬第一醫(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。方法對國內(nèi)、外相關文獻進行綜述分析。結果肝癌破裂出血的病因目前仍不完全清楚，我國肝癌破裂出血與乙肝病毒感染導致抗原抗體復合物沉積于腫瘤小動脈壁致其損傷繼而破裂出血關系密切。治療方法有保守治療、手術治療（肝葉切除、肝動脈結扎術、縫扎填塞）、肝動脈插管栓塞術、其他治療（無水乙醇瘤內(nèi)注射、射頻消融、生物免疫療法等）。結論肝動脈插管栓塞術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。

引用本文： 張華,羅詩樵,吳忠均. 肝癌破裂出血的診斷和治療. 中國普外基礎與臨床雜志, 2011, 18(12): 1338-1343. doi: 復制

1. 夏鋒. 肝癌的分子分型與肝癌的診治 [J]. 實用臨床醫(yī)藥雜志, 2010, 14(13): 1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. 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. 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. 肝癌自發(fā)性破裂患者血管超微結構研究 [J]. 中華外科雜志, 2006, 44(3): 161164.
15. 呂成超, 朱立新. 肝癌自發(fā)性破裂機理的研究進展 [J]. 中國普外基礎與臨床雜志, 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.
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. 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. 急診手術治療原發(fā)性肝癌破裂出血的臨床分析 [J]. 實用醫(yī)學雜志, 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)性破裂出血介入動脈栓塞治療 [J]. 中國癌癥雜志, 2005, 15(3): 285287.
25. 辜斌, 李小松. 肝癌破裂出血的肝動脈栓塞治療 [J]. 實用臨床醫(yī)學, 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]. 當代醫(yī)學, 2009, 15(29): 572573.
27. 王旭. 肝動脈化療栓塞術治療肝癌破裂出血的臨床價值 [J]. 中國現(xiàn)代普通外科進展, 2008, 11(6): 546547.
28. 張貴德, 姜成文, 宋希江. 肝動脈栓塞治療26例原發(fā)性肝癌自發(fā)性破裂出血 [J]. 中國腫瘤臨床, 2007, 34(14): 833834.
29. 孟環(huán). 急診介入治療肝癌破裂出血 [J]. 臨床醫(yī)學, 2008, 28(12): 8283.
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]. 中國現(xiàn)代普通外科進展, 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]. 中華放射學雜志, 1994, 28(2): 9396.
33. 羅志強, 汪家珠, 莊陽輝, 等. 原發(fā)性肝癌自發(fā)破裂出血的手術治療(附28例報告) [J]. 中華肝膽外科雜志, 2005, 11(3): 205206.
34. 肖玉根, 楊清水. 手術治療肝癌破裂出血32例 [J]. 中國醫(yī)藥, 2006, 1(8): 476477.
35. 吳安任. 手術治療原發(fā)性肝癌并發(fā)破裂出血的生存分析 [J]. 醫(yī)學信息, 2009, 22(7): 12631265.
36. 韓國秀, 王剛. 原發(fā)性肝癌破裂出血18例手術治療體會 [J]. 河南外科學雜志, 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 [J]. 中國當代醫(yī)藥, 2010, 17(1): 144.
38. 蔡海. 原發(fā)性肝癌自發(fā)性破裂出血的特點和治療分析 [J]. 肝膽外科雜志, 2007, 15(3): 186188.
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)科大學學報(自然科學版), 2007, 27(11): 13391340.
40. 李志壯, 曲新國, 宋秀玲. 原發(fā)性肝癌破裂出血的外科處理 [J]. 中國醫(yī)藥導報, 2008, 5(19): 125.
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]. 中華普外科手術學雜志(電子版), 2010, 4(2): 193195.
43. Buczkowski AK, Kim PT, Ho SG, et al. Multidisciplinary management of ruptured hepatocellular carcinoma [J]. J Gastrointest Surg, 2006, 10(3): 379386.
44. Chiappa A, Zbar A, Audisio RA, et al. Emergency liver resection for ruptured hepatocellular carcinoma complicating cirrhosis [J]. Hepatogastroenterology, 1999, 46(26): 11451150.
45. 徐海燕. 原發(fā)性肝癌自發(fā)性破裂出血治療分析 [D]. 長沙: 中南大學, 2010: 141.
46. 賀強, 陳大志, 郎韌, 等. 急診肝移植治療暴發(fā)性肝功能衰竭四例 [J]. 中華器官移植雜志, 2005, 26(5): 289291.
47. 傅仁勇, 董昕, 劉祝. 原發(fā)性肝癌破裂出血的急診治療策略 [J]. 腹部外科, 2005, 18(4): 218219.
48. Ng KK, Lam CM, Poon RT, et al. Radiofrequency ablation as a salvage procedure for ruptured hepatocellular carcinoma [J]. Hepatogastroenterology, 2003, 50(53): 16411643.
49. Kobayashi M, Ikeda K, Hosaka T, et al. Successful control of ruptured hepatocellular carcinoma with radiofrequency ablation [J]. J Gastroenterol, 2004, 39(2): 192193.
50. Fuchizaki U, Miyamori H, Kitagawa S, et al. Radiofrequency ablation for lifethreatening ruptured hepatocellular carcinoma [J]. J Hepatol, 2004, 40(2): 354355.
51. Manikam J, Mahadeva S, Goh KL, et al. Percutaneous, nonoperative radio frequency ablation for haemostasis of ruptured hepatocellular carcinoma [J]. Hepatogastroenterology, 2009, 56(89): 227230.
52. Shiratori M, Nagashima I, Takada T, et al. Successful treatment of ruptured hepatocellular carcinoma with intraperitoneal injection of OK432 [J]. J Hepatobiliary Pancreat Surg, 2004, 11(6): 426429.
  1. 1. 夏鋒. 肝癌的分子分型與肝癌的診治 [J]. 實用臨床醫(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. 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. 肝癌自發(fā)性破裂患者血管超微結構研究 [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)性破裂機理的研究進展 [J]. 中國普外基礎與臨床雜志, 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. 急診手術治療原發(fā)性肝癌破裂出血的臨床分析 [J]. 實用醫(yī)學雜志, 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)性破裂出血介入動脈栓塞治療 [J]. 中國癌癥雜志, 2005, 15(3): 285287.
  25. 25. 辜斌, 李小松. 肝癌破裂出血的肝動脈栓塞治療 [J]. 實用臨床醫(yī)學, 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]. 當代醫(yī)學, 2009, 15(29): 572573.
  27. 27. 王旭. 肝動脈化療栓塞術治療肝癌破裂出血的臨床價值 [J]. 中國現(xiàn)代普通外科進展, 2008, 11(6): 546547.
  28. 28. 張貴德, 姜成文, 宋希江. 肝動脈栓塞治療26例原發(fā)性肝癌自發(fā)性破裂出血 [J]. 中國腫瘤臨床, 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, 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]. 中國現(xiàn)代普通外科進展, 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]. 中華放射學雜志, 1994, 28(2): 9396.
  33. 33. 羅志強, 汪家珠, 莊陽輝, 等. 原發(fā)性肝癌自發(fā)破裂出血的手術治療(附28例報告) [J]. 中華肝膽外科雜志, 2005, 11(3): 205206.
  34. 34. 肖玉根, 楊清水. 手術治療肝癌破裂出血32例 [J]. 中國醫(yī)藥, 2006, 1(8): 476477.
  35. 35. 吳安任. 手術治療原發(fā)性肝癌并發(fā)破裂出血的生存分析 [J]. 醫(yī)學信息, 2009, 22(7): 12631265.
  36. 36. 韓國秀, 王剛. 原發(fā)性肝癌破裂出血18例手術治療體會 [J]. 河南外科學雜志, 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 [J]. 中國當代醫(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)科大學學報(自然科學版), 2007, 27(11): 13391340.
  40. 40. 李志壯, 曲新國, 宋秀玲. 原發(fā)性肝癌破裂出血的外科處理 [J]. 中國醫(yī)藥導報, 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]. 中華普外科手術學雜志(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.
  44. 44. Chiappa A, Zbar A, Audisio RA, et al. Emergency liver resection for ruptured hepatocellular carcinoma complicating cirrhosis [J]. Hepatogastroenterology, 1999, 46(26): 11451150.
  45. 45. 徐海燕. 原發(fā)性肝癌自發(fā)性破裂出血治療分析 [D]. 長沙: 中南大學, 2010: 141.
  46. 46. 賀強, 陳大志, 郎韌, 等. 急診肝移植治療暴發(fā)性肝功能衰竭四例 [J]. 中華器官移植雜志, 2005, 26(5): 289291.
  47. 47. 傅仁勇, 董昕, 劉祝. 原發(fā)性肝癌破裂出血的急診治療策略 [J]. 腹部外科, 2005, 18(4): 218219.
  48. 48. Ng KK, Lam CM, Poon RT, et al. Radiofrequency ablation as a salvage procedure for ruptured hepatocellular carcinoma [J]. Hepatogastroenterology, 2003, 50(53): 16411643.
  49. 49. Kobayashi M, Ikeda K, Hosaka T, et al. Successful control of ruptured hepatocellular carcinoma with radiofrequency ablation [J]. J Gastroenterol, 2004, 39(2): 192193.
  50. 50. Fuchizaki U, Miyamori H, Kitagawa S, et al. Radiofrequency ablation for lifethreatening ruptured hepatocellular carcinoma [J]. J Hepatol, 2004, 40(2): 354355.
  51. 51. Manikam J, Mahadeva S, Goh KL, et al. Percutaneous, nonoperative radio frequency ablation for haemostasis of ruptured hepatocellular carcinoma [J]. Hepatogastroenterology, 2009, 56(89): 227230.
  52. 52. Shiratori M, Nagashima I, Takada T, et al. Successful treatment of ruptured hepatocellular carcinoma with intraperitoneal injection of OK432 [J]. J Hepatobiliary Pancreat Surg, 2004, 11(6): 426429.