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