<総説>肝癌自然破裂

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Spontaneous rupture of hepatocellular carcinoma, so-called acute abdominal type of hepatocellular carcinoma, is found to be of comparatively frequent occurrence in Japan. But its clinical characteristics and treatments have been unknown so well. In this communication 172 cases of spontaneous rupture of hepatocellular carcinoma reported in the Japanese literature including our 2 cases during the period from 1935 to December 1987 are reviewed. The age ranged from 21 to 84 years, with an average of 54.8 years and with male-to-female ratio of 5.6 : 1. Sudden epigastralgia or pain in the right hypochondrium appeared initially in 66.4% (79/119) and accompanied by hemorrhagic shock in 61.7% (58/94), and accompanied by liver cirrhosis in 77.3% (65/84). The treatment consisted of transcatheter arterial embolization in 57 cases (33.1%), one-stage hepatectomy in 31 cases (18.0%), suture and/or packing in 30 cases (17.4%), two-stage hepatectomy in 21 cases (12.2%), conservative therapy in 14 cases (8.2%), hepatic artery ligation in 10 cases (5.8%), and some others (microwave coagulation therapy, intermittent hepatic artery occlusion). The prognosis for all the cases was 0-1,825 days, and the mean survival period was 148.9 days. The three month survival rate and mean survival period were respectively 89.4%, 380.7±89.8 (m±SD) days in two-stage hepatectomy, 59.5%, 247.0±54.7 days in one-stage hepatectomy, 35.0%, 100.9±16.5 days in transcatheter arterial embolization, 26.9%, 81.5±27.9 days in suture and/or packing, 13.9%, 39.6±11.7 days in hepatic artery ligation, 10.0%, 19.2+8.9 days in conservative therapy. Thus there were significant differences between two-stage hepatectomy group and the other treatment groups (p<0.05). Giving consideration also to the fact that 42.2% of the known causes of death in the cases we reviewed was occupied by liver failure, we recommend two-stage hepatectomy for the treatment of spontaneous rupture of hepatocellular carcinoma because of the long period of survival.
近畿大学の論文
1988-09-25

<総説>肝癌自然破裂

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