不同时间窗手术治疗原发性肝癌自发破裂出血患者2年生存率比较*

doi:10.3969/j.issn.1672-5069.2023.02.031

摘要/Abstract

摘要： 目的比较研究不同时间窗手术治疗原发性肝癌(PLC)自发破裂出血患者2 a生存率的差异。方法 2014年1月～2019年1月我院诊治的PLC自发破裂出血患者74例,其中31例在发病2周内手术(早期手术组),另43例于发病2周后手术(延期手术组),均接受肿瘤切除联合大网膜切除术和腹腔热灌注治疗,术后随访2年。结果在随访2年内,早期手术组大网膜侵犯发生率为3.2%,显著低于延期手术组的20.9%(P＜0.05),但两组肝内肿瘤复发、肺转移和腹腔转移发生率无显著性差异(P＞0.05);术后,两组并发症,如术后出血、腹水、肝衰竭和腹腔感染发生率比较无显著性差异(25.8%对32.6%,P＞0.05);在随访期间,早期手术组死亡5例,26例(83.9%)生存,延期手术组死亡8例,35例(81.4%,P＞0.05)生存;早期手术组中位无病生存时间为17(10,23)个月,显著长于延期手术组的11(4,14)个月(Z=3.865,P＜0.05);早期手术组中位生存时间为22(16,24)个月,延期手术组为20(14,24)个月,无显著性差异(P＞0.05)。结论无论采取早期还是延期手术治疗肝癌自发性破裂出血患者2 a生存率较高,临床可根据患者具体病情,积极准备手术治疗。

关键词: 原发性肝癌, 自发破裂出血, 大网膜切除, 腹腔热灌注, 手术时间窗, 治疗

Abstract: Objective The purpose of this study was to compare the two-year survivals in primary liver cancer (PLC) patients with spontaneous tumor rupture underwent hepatectomy at early or late operation time windows. Methods A total of 74 PLC patients with spontaneous tumor rupture were admitted to our hospital between January 2014 and January 2019, and all received hepatectomy, greater omentum resection and abdominal heat perfusion. 31 patients (early surgery) received theoperation within two weeks, and 43 patients (late surgery) received the operation two weeks after onset of the disease. All patients were followed-up for two years. Results Within two year follow-up period, the incidence of greater omentum invasion in patients receiving early operation was 3.2%, much lower than 20.9%(P＜0.05) in patients receiving late operation, while there were no significant differences as respect to the incidences of intrahepatic tumor recurrence, pulmonary metastasis and intraperitoneal metastasis (P＞0.05) between the two groups; post-operationally, there were no significant differences as respect to the incidences of complications, such as bleeding, ascites, liver failure and peritoneal infections(25.8% vs. 32.6%,P＞0.05); during two-year follow-up period, 5 patients died and 26 patients (83.9%) survived in patients receiving early operation, and 8 patients died and 35 patients (81.4%,P＞0.05) survived in patients receiving late surgery; the median disease-free survival in patients receiving early operation was 17(10, 23) months, significantly longer than 11(4,14) months(Z=3.865, P＜0.05) in patients receiving late operation; the overall survival in patients receiving early operation was 22(16, 24) months, not significantly different as compared to 20(14, 24) months in patients receiving late operation (P＞0.05). Conclusion The hepatectomy could rescue the PLC patients’ life when tumor rupture occurs, so the clinicians should actively prepare for the operation no mater early or late times.

Key words: Hepatoma, Spontaneous tumor rupture, Greater omentum resection, Abdominal heat perfusion therapy, Operation time window, Therapy

龚程, 田银生, 刘爽. 不同时间窗手术治疗原发性肝癌自发破裂出血患者2年生存率比较^*[J]. 实用肝脏病杂志, 2023, 26(2): 274-277.

Gong Cheng, Tian Yinsheng, Liu Shuang. Comparison of two-year survivals in primary liver cancer patients with spontaneous tumor rupture underwent hepatectomy at early or late operation time windows[J]. Journal of Practical Hepatology, 2023, 26(2): 274-277.

参考文献

[1] Chua DW, Koh YX, Allen JC, et al. Impact of spontaneous rupture on the survival outcomes after liver resection for hepatocellular carcinoma: a propensity matched analysis comparing ruptured versus non-ruptured tumors. Eur J Surg Oncol, 2019, 45(9): 1652-1659.
[2] 张园园, 邓敏, 王浩文, 等. 原发性肝癌自发性破裂出血继发感染的救治与护理. 中华临床感染病杂志, 2021, 14(3): 213-215.
[3] Yang JW, Li Y, Xie K, et al. Spontaneous rupture of hepatic epithelioid hemangioendothelioma: a case report. World J Gastroenterol, 2017, 23(1): 185-190.
[4] Schwarz L, Bubenheim M, Zemour J, et al. Bleeding recurrence and mortality following interventional management of spontaneous HCC rupture: results of a multicenter European study. World J Surg, 2018, 42(1): 225-232.
[5] Suoh M, Hagihara A, Kageyama K, et al. Successful transcatheter arterial embolization for hemothorax from a spontaneous rupture of hepatocellular carcinoma metastasis to the chest wall in an elderly patient. Intern Med, 2021, 60(14): 2223-2228.
[6] 黄小准, 王春玲, 黄璋侃, 等. 急诊切除或肝动脉栓塞术后二期切除治疗肝癌自发破裂出血近远期疗效的荟萃分析. 中华肝胆外科杂志, 2021, 27(11): 852-857.
[7] 中华人民共和国卫生部. 原发性肝癌诊疗规范(2011年版). 中华肝脏病杂志, 2012, 20(6): 419-426.
[8] Sugihara T, Koda M, Okamoto T, et al. Two patterns of contrast-enhanced ultrasonography with sonazoid in spontaneous rupture of hepatocellular carcinoma: a report of four cases. J Med Ultrason (2001), 2018, 45(2): 319-323.
[9] Rossi UG, Camisassi N, Pinna F, et al. Spontaneous hepatic haemangioma rupture and hemoperitoneum: a double problem with a single stage interventional radiology solution. Clin Exp Emerg Med, 2019, 6(2): 169-172.
[10] Yágüez JB, Trill JD, Pérez JCG. Spontaneous liver rupture secondary to distal right hepatic artery microaneurysms in a patient admitted due to staphylococcus aureus pneumonia. Rev Esp Enferm Dig, 2019, 111(3): 250-251.
[11] Hiramatsu S, Yanagawa K, Matsunaga N, et al. A case of spontaneous rupture of non-viral hepatocellular carcinoma with subcapsular hematoma. Gan To Kagaku Ryoho, 2019, 46(13): 2090-2092.
[12] Lee HS, Choi GH, Choi JS, et al. Staged partial hepatectomy versus transarterial chemoembolization for the treatment of spontaneous hepatocellular carcinoma rupture: a multicenter analysis in korea. Ann Surg Treat Res, 2019, 96(6): 275-282.
[13] Zhu Q, Qiao G, Xu C, et al. Conditional survival in patients with spontaneous tumor rupture of hepatocellular carcinoma after partial hepatectomy: a propensity score matching analysis. HPB (Oxford, 2019, 21(6): 722-730.
[14] Roussel E, Bubenheim M, Treut YPL, et al. Peritoneal carcinomatosis risk and long-term survival following hepatectomy for spontaneous hepatocellular carcinoma rupture: results of a multicenter french study (french-afc). Ann Surg Oncol, 2020, 27(9): 3383-3392.
[15] Zhang W, Zhang ZW, Zhang BX, et al. Outcomes and prognostic factors of spontaneously ruptured hepatocellular carcinoma. J Gastrointest Surg, 2019, 23(9): 1788-1800.
[16] Plahuta I, Jelenko M, Potr S, et al. Abandonment of surveillance, followed by emergency surgery for a second spontaneous rupture of hepatocellular carcinoma: a case report and review of the literature. Clin Case Rep, 2019, 7(4): 789-796.
[17] 何泳铸, 何坤, 王泽亮, 等. 腹腔热灌注化疗在肝癌破裂出血术后肿瘤复发中的应用价值. 中华肝胆外科杂志, 2020, 26(6): 431-434.
[18] Ren A, Luo S, Ji L, et al. Peritoneal metastasis after emergency hepatectomy and delayed hepatectomy for spontaneous rupture of hepatocellular carcinoma. Asian J Surg, 2019, 42(2): 464-469.
[19] Kabir T, Tan ZZX, Chua DW, et al. Early experience with laparoscopic liver resection for spontaneously ruptured hepatocellular carcinoma. J Minim Access Surg, 2020, 16(3): 239-245.
[20] 杨先模, 闫挺, 任翱, 等. 急诊与延期肝切除对可切除性肝癌破裂出血患者腹腔转移的影响. 中华肝胆外科杂志, 2017, 23(4): 225-229.

不同时间窗手术治疗原发性肝癌自发破裂出血患者2年生存率比较^*

Comparison of two-year survivals in primary liver cancer patients with spontaneous tumor rupture underwent hepatectomy at early or late operation time windows

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