老年肝癌自发性破裂的早期表现与治疗.pdfVIP

军 医 进 修 学 院 学 报 ·314 · 2004 Aug ，25 （4 ） Acad J PLA Postgrad Med Sch ［文章编号］1005-1139（2004 ）04-0314-02 老年肝癌自发性破裂的早期表现与治疗 蔡昌豪，吴本俨，吴道宏，王孟薇 （解放军总医院老年消化科，北京 100853 ） ［摘要］ 目的：总结老年人肝癌破裂出血临床特点、诊断治疗经验。方法：回顾分析8 例（14 例次）肝癌破裂 出血发病临床症状、体征。结果：8 例占同期肝癌的11. 42% （8/ 70 ），静态发病、腹痛即刻达高峰，转移性下腹疼痛， 伴出汗、恶心、呕吐，大便频；腹腔积血；超声提示有腹腔积液。经导管动脉栓塞 （TAE ）出血即刻停止，经手术切除 者存活2 731 d 。结论：老年肝癌患者突发腹痛、出汗、便频常是肝癌破裂出血的信号，超声发现新的腹腔积液、或原 有积液增多，腹腔穿刺证实腹腔积血。一般治疗补充血容量稳定生命体征；TAE 是首选治疗方法，以后择期手术。 ［关键词］肝细胞癌；破裂性出血 ［中图分类号］ R735. 7 ［文献标识码］A Early manifestation and treatment of ruptured hepatocellular carcinoma in the elderly CAI Chang-hao ，WU Ben-yan ，WU Dao-hong ，WANG Meng-wei （Dep artment of Geriatric Gastroenterology ， PLA General Hosp ital ，Beij ing 100853 ，China ） ［Abstract ］ Objective ：To summarize cIinicaI features ，experience of diagnosis and treatment of rupture hepatoceIIuIar carcino- ma（HCC ）. Methods ：Eight patients with ruptured HCC who were surgicaIIy or conservativeIy treated were retrospectiveIy ana- Iyzed in terms of cIinicaI features，modaIity of treatment ，survivaI time ，and cause of death. Results ：The patients were admitted to the hospitaI from 1987 to 2002 ，accouting for 11. 42% （8/ 70 ）of aII hospitaIized patients with HCC in the same period. Out of them seven patients were maIe ，one patient was femaIe. Sudden epigastric or right hypochondriac pain which decrease graduaIIy with sweat ，nausea ，vomiting ，hypotension and diarrhea. BIood pressures were Iower than 90/ 60 mmHg in 6 patients and 87 . 5% （7/ 8 ）have signs