损伤控制性手术原则治疗原发性肝癌自发性破裂大出血患者止血效果研究*

doi:10.3969/j.issn.1672-5069.2026.02.033

实用肝脏病杂志 ›› 2026, Vol. 29 ›› Issue (2): 293-296.doi: 10.3969/j.issn.1672-5069.2026.02.033

损伤控制性手术原则治疗原发性肝癌自发性破裂大出血患者止血效果研究^*

孙志青, 赵彦娜, 贺祥昆, 葛晨

214000 江苏省无锡市解放军联勤保障部队第904医院胃肠外科(孙志青);肝胆胰外科(贺祥昆);普通外科(赵彦娜);东南大学附属中大医院无锡分院/无锡市锡山人民医院普通外科(葛晨)

收稿日期:2025-11-10 出版日期:2026-03-10 发布日期:2026-03-13
通讯作者: 贺祥昆,E-mail:Hexiangkun1003@126.com
作者简介:孙志青,女,41岁,大学本科。E-mail:13771440226@163.com
基金资助:
^*江苏省自然科学基金资助项目(编号:BK20210687)

Emergent management of patients with primary liver cancer complicated with spontaneous rupture bleeding under principle of damage control surgery

Sun Zhiqing, Zhao Yanna, He Xiangkun, et al

Department of Gastrointestinal Surgery, 904th Hospital, Joint Logistics Support Force, Wuxi 214000, Jiangsu Province, China

Received:2025-11-10 Online:2026-03-10 Published:2026-03-13

摘要/Abstract

摘要： 目的探讨损伤控制性手术(DCS)处理原发性肝癌(PLC)自发性破裂大出血患者的治疗效果。方法 2022年6月～2025年6月我院收治的PLC并发自发性破裂大出血患者43例,其中22例接受DCS原则下的临时止血和二期手术切除肿瘤,另21例接受常规开腹手术切除肿瘤和止血。采用ELISA法检测血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和C反应蛋白(CRP)水平。使用全自动凝血分析仪检测活化部分凝血活酶时间(APTT)、凝血酶时间(TT)和凝血酶原时间(PT)。结果 DCS组抢救成功率为90.9%,显著高于常规组的71.4%(P＜0.05);DCS生存患者术中出血量、手术时间、休克纠正时间、体温恢复时间分别为(782.6±96.3)mL、(149.5±33.6)min、(6.5±1.7)h和(8.2±1.9)h,均显著少于或短于常规手术组的生存患者【分别为(1085.4±116.9)mL、(188.5±37.2)min、(9.3±2.6)h和(15.4±2.2)h,P＜0.05】,而住院日为(15.9±4.5)d,显著长于常规组【(10.6±5.2)d,P＜0.05】;术后,DCS组血清IL-6、TNF-α和CRP水平分别为(39.4±8.1)pg/mL、(23.8±4.6)ng/mL和(14.2±3.5)mg/L,均显著低于常规组【分别为(72.9±13.6)pg/mL、(38.5±6.2)ng/mL和(23.5±4.2)mg/L,P＜0.05】;手术前后两组凝血功能指标变化无显著性差异(P>0.05); 术后,DCS组并发症发生率为5.0%,显著低于常规组的26.7%(P＜0.05)。结论遵守DCS原则开展二期手术处理PLC并发自发性破裂大出血患者或可提高抢救成功率,可能与给予相对缓和的止血后恢复机体功能的机会有关。

关键词: 原发性肝癌, 自发性破裂大出血, 损伤控制性手术, 治疗

Abstract: Objective The aim of this study was to investigate emergent management of patients with primary liver cancer (PLC) complicated with spontaneous rupture bleeding under principle of damage controlsurgery(DCS). Methods 43 patients with spontaneous tumor rupture and massive hemorrhage were encountered in our hospital between June 2022 and June 2025,and emergent packing hemostasis and second-stage tumor resection was conducted in 22 cases and one-stage conventional surgery was performed in another 21 cases; Serum interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)and C-reactive protein (CRP) levels were detected by ELISA.The activated partial thromboplastin time (APTT), thrombin time (TT) and prothrombin time (PT) were detected routinely. Results Rescue success rate in the DCS group was 90.9%, significantly higher than 71.4% in the conventional group (P＜0.05); intra-operational blood loss, operation time, shock reversal time and body temperature recovery time in the DCS group were(782.6±96.3)mL, (149.5±33.6)min, (6.5±1.7)h and (8.2±1.9)h, all significantly less or shorter than [(1085.4±116.9)mL, (188.5±37.2)min, (9.3±2.6)h and (15.4±2.2)h, respectively, P＜0.05], while hospital stay was (15.9±4.5)d, significantly longer than [(10.6±5.2)d, P＜0.05] in conventional group; post-operationally, serum IL-6, TNF-α and CRP levels were (39.4±8.1)pg/mL, (23.8±4.6)ng/mL and (14.2±3.5)mg/L, all much lower than [(72.9±13.6)pg/mL, (38.5±6.2)ng/mL and (23.5±4.2)mg/L, respectively, P＜0.05] in the conventional group; there were no significant differences respect to coagulation parameters between the two groups (P>0.05); incidences of complications in DCS group was 5.0%, much lower than 26.7%(P＜0.05) in the conventional surgery group. Conclusion We recommend emergent packing hemostasis and second-stage tumor resection under DCS principle in dealing with patients with PLC and spontaneous tumor rupture, which might increase rescue success rates.

Key words: Hepatoma, Spontaneous rupture, Damage control surgery, Treatment

孙志青, 赵彦娜, 贺祥昆, 葛晨. 损伤控制性手术原则治疗原发性肝癌自发性破裂大出血患者止血效果研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 293-296.

Sun Zhiqing, Zhao Yanna, He Xiangkun, et al. Emergent management of patients with primary liver cancer complicated with spontaneous rupture bleeding under principle of damage control surgery[J]. Journal of Practical Hepatology, 2026, 29(2): 293-296.

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损伤控制性手术原则治疗原发性肝癌自发性破裂大出血患者止血效果研究^*

Emergent management of patients with primary liver cancer complicated with spontaneous rupture bleeding under principle of damage control surgery

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