Diagnosis and Treatment for Spontaneous Rupture of Hepatocellular Carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Hua , LUO Shiqiao ,  WU Zhongjun.

Department of Hepatobiliary Surgery, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China;

Corresponding author：

WU Zhongjun., Email: zjingjing1011@163.com

Keywords：

Hepatocellular carcinoma; Spontaneous rupture; Treatment

Video：

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ObjectiveTo study the mechanisms of spontaneous rupture of hepatocellular carcinoma and the treatments in the acute phase and the second phase after hemostasis. MethodsRelated domestic and foreign literatures were reviewed. ResultsThe mechanism of spontaneous rupture of hepatocellular carcinoma was still not quite clear. In China, spontaneous rupture of hepatocellular carcinoma was closely related with hepatitis B virus infection. Immune complex deposition in vessel wall led to the injuries of small arteries and bleeding. Treatments included conservative therapy, surgical intervention （lobectomy of liver, hepatic artery ligation, packing, and suturing), transarteial embolization, other medications (percutaneous ethanol injection, radiofrequency ablation, bio-immunotherapy). ConclusionTransarterial embolization has been shown to be highly effective in achieving immediate hemostasis, and can be used as the basis of phase two comprehensive treatment.

Citation： ZHANG Hua,LUO Shiqiao,WU Zhongjun.. Diagnosis and Treatment for Spontaneous Rupture of Hepatocellular Carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(12): 1338-1343. doi: Copy

1.	夏锋. 肝癌的分子分型与肝癌的诊治 [J]. 实用临床医药杂志, 2010, 14(13): 12.
2.	Globocan 2008 (IARC). Liver cancer incidence and mortality worldwide in 2008 summary [EB/OL]. http://globocan.iarc.fr/factsheets/cancers/liver.asp.
3.	Battula N, Madanur M, Priest O, et al. Spontaneous rupture of hepatocellular carcinoma: a Western experience [J]. Am J Surg, 2009, 197(2): 164167.
4.	Miyamoto M, Sudo T, Kuyama T. Spontaneous rupture of hepatocellular carcinoma: a review of 172 Japanese cases [J]. Am J Gastroenterol, 1991, 86(1): 6771.
5.	Tanaka A, Takeda R, Mukaihara S, et al. Treatment of ruptured hepatocellular carcinoma [J]. Int J Clin Oncol, 2001, 6(6): 291295.
6.	Kew MC, Hodkinson J. Rupture of hepatocellular carcinoma as a result of blunt abdominal trauma [J]. Am J Gastroenterol, 1991, 86(8): 10831085.
7.	Hermann RE, David TE. Spontaneous rupture of the liver caused by hepatomas [J]. Surgery, 1973, 74(5): 715719.
8.	Nagasue N, Inokuchi K, Kobayashi M, et al. Hepatoportal arteriovenous fistula in primary carcinoma of the liver [J]. Surg Gynecol Obstet, 1977, 145(4): 504508.
9.	Kanematsu M, Imaeda T, Yamawaki Y, et al. Rupture of hepatocellular carcinoma: predictive value of CT findings [J]. AJR Am J Roentgenol, 1992, 158(6): 12471250.
10.	Zhu LX, Geng XP, Fan ST. Spontaneous rupture of hepatocellular carcinoma and vascular injury [J]. Arch Surg, 2001, 136(6): 682687.
11.	Zhu LX, Liu Y, Fan ST. Ultrastructural study of the vascular endothelium of patients with spontaneous rupture of hepatocellular carcinoma [J]. Asian J Surg, 2002, 25(2): 157162.
12.	Zhu LX, Meng XL, Fan ST. Elasticity of small artery in patient with spontaneous rupture of hepatocellular carcinoma [J]. Hepatol Res, 2004, 29(1): 1317.
13.	朱立新, 耿小平, 范上达. 肝癌自发性破裂病因探讨 [J]. 中华外科杂志, 2004, 42(17): 10361039.
14.	朱立新, 耿小平, 范上达. 肝癌自发性破裂患者血管超微结构研究 [J]. 中华外科杂志, 2006, 44(3): 161164.
15.	吕成超, 朱立新. 肝癌自发性破裂机理的研究进展 [J]. 中国普外基础与临床杂志, 2006, 13(2): 181183.
16.	马连峰. 原发性肝癌自发性破裂出血误诊分析 [J]. 河南肿瘤学杂志, 2003, 16(1): 3333.
17.	Vergara V, Muratore A, Bouzari H, et al. Spontaneous rupture of hepatocelluar carcinoma: surgical resection and longterm survival [J]. Eur J Surg Oncol, 2000, 26(8): 770772.
18.	Yeh CN, Lee WC, Jeng LB, et al. Spontaneous tumour rupture and prognosis in patients with hepatocellular carcinoma [J]. Br J Surg, 2002, 89(9): 11251129.
19.	Kim PT, Su JC, Buczkowski AK, et al. Computed tomography and angiographic interventional features of ruptured hepatocellular carcinoma: pictorial essay [J]. Can Assoc Radiol J, 2006, 57(3): 159168.
20.	Kung CT, Liu BM, Ng SH, et al. Transcatheter arterial embolization in the emergency department for hemodynamic instability due to ruptured hepatocellular carcinoma: analysis of 167 cases [J]. AJR Am J Roentgenol, 2008, 191(6): W231W239.
21.	Lai EC, Lau WY. Spontaneous rupture of hepatocellular carcinoma: a systematic review [J]. Arch Surg, 2006, 141(2): 191198.
22.	Kirikoshi H, Saito S, Yoneda M, et al. Outcomes and factors influencing survival in cirrhotic cases with spontaneous rupture of hepatocellular carcinoma: a multicenter study [J]. BMC Gastroenterol, 2009, 9: 29.
23.	朱光辉, 翁杰锋, 温敏杰. 急诊手术治疗原发性肝癌破裂出血的临床分析 [J]. 实用医学杂志, 2008, 24(19): 33893390.
24.	汪建成, 胡道予, 姚洪亮, 等. 原发性肝癌自发性破裂出血介入动脉栓塞治疗 [J]. 中国癌症杂志, 2005, 15(3): 285287.
25.	辜斌, 李小松. 肝癌破裂出血的肝动脉栓塞治疗 [J]. 实用临床医学, 2008, 9(10): 4143.
26.	曾俊仁, 向述天, 徐松, 等. 肝癌破裂出血介入栓塞治疗疗效分析 [J]. 当代医学, 2009, 15(29): 572573.
27.	王旭. 肝动脉化疗栓塞术治疗肝癌破裂出血的临床价值 [J]. 中国现代普通外科进展, 2008, 11(6): 546547.
28.	张贵德, 姜成文, 宋希江. 肝动脉栓塞治疗26例原发性肝癌自发性破裂出血 [J]. 中国肿瘤临床, 2007, 34(14): 833834.
29.	孟环. 急诊介入治疗肝癌破裂出血 [J]. 临床医学, 2008, 28(12): 8283.
30.	范永斌, 孙思敬. 原发性肝癌自发破裂出血的外科治疗 [J]. 中国现代普通外科进展, 2008, 11(5): 440441.
31.	Caruso DM, Battistella FD, Owings JT, et al. Perihepatic packing of major liver injuries: complications and mortality [J]. Arch Surg, 1999, 134(9): 958962.
32.	田建明, 王飞, 叶华, 等. 肝癌的规则性、变异性供血及其临床意义 [J]. 中华放射学杂志, 1994, 28(2): 9396.
33.	罗志强, 汪家珠, 庄阳辉, 等. 原发性肝癌自发破裂出血的手术治疗(附28例报告) [J]. 中华肝胆外科杂志, 2005, 11(3): 205206.
34.	肖玉根, 杨清水. 手术治疗肝癌破裂出血32例 [J]. 中国医药, 2006, 1(8): 476477.
35.	吴安任. 手术治疗原发性肝癌并发破裂出血的生存分析 [J]. 医学信息, 2009, 22(7): 12631265.
36.	韩国秀, 王刚. 原发性肝癌破裂出血18例手术治疗体会 [J]. 河南外科学杂志, 2009, 15(1): 60.
37.	尹修才, 董建伟, 李新成. 肝癌破裂出血21例外科处理体会 [J]. 中国当代医药, 2010, 17(1): 144.
38.	蔡海. 原发性肝癌自发性破裂出血的特点和治疗分析 [J]. 肝胆外科杂志, 2007, 15(3): 186188.
39.	许建伟, 赵文娟. 原发性肝癌自发性破裂出血的临床分析 [J]. 南京医科大学学报(自然科学版), 2007, 27(11): 13391340.
40.	李志壮, 曲新国, 宋秀玲. 原发性肝癌破裂出血的外科处理 [J]. 中国医药导报, 2008, 5(19): 125.
41.	姚少清. 原发性肝癌自发性破裂出血临床观察 [J]. 中华实用诊断与治疗杂志, 2008, 22(12): 941942.
42.	陈凌岩, 王伟, 陈骥, 等. 原发性肝癌自发性破裂外科治疗81例分析 [J]. 中华普外科手术学杂志(电子版), 2010, 4(2): 193195.
43.	Buczkowski AK, Kim PT, Ho SG, et al. Multidisciplinary management of ruptured hepatocellular carcinoma [J]. J Gastrointest Surg, 2006, 10(3): 379386.
44.	Chiappa A, Zbar A, Audisio RA, et al. Emergency liver resection for ruptured hepatocellular carcinoma complicating cirrhosis [J]. Hepatogastroenterology, 1999, 46(26): 11451150.
45.	徐海燕. 原发性肝癌自发性破裂出血治疗分析 [D]. 长沙: 中南大学, 2010: 141.
46.	贺强, 陈大志, 郎韧, 等. 急诊肝移植治疗暴发性肝功能衰竭四例 [J]. 中华器官移植杂志, 2005, 26(5): 289291.
47.	傅仁勇, 董昕, 刘祝. 原发性肝癌破裂出血的急诊治疗策略 [J]. 腹部外科, 2005, 18(4): 218219.
48.	Ng KK, Lam CM, Poon RT, et al. Radiofrequency ablation as a salvage procedure for ruptured hepatocellular carcinoma [J]. Hepatogastroenterology, 2003, 50(53): 16411643.
49.	Kobayashi M, Ikeda K, Hosaka T, et al. Successful control of ruptured hepatocellular carcinoma with radiofrequency ablation [J]. J Gastroenterol, 2004, 39(2): 192193.
50.	Fuchizaki U, Miyamori H, Kitagawa S, et al. Radiofrequency ablation for lifethreatening ruptured hepatocellular carcinoma [J]. J Hepatol, 2004, 40(2): 354355.
51.	Manikam J, Mahadeva S, Goh KL, et al. Percutaneous, nonoperative radio frequency ablation for haemostasis of ruptured hepatocellular carcinoma [J]. Hepatogastroenterology, 2009, 56(89): 227230.
52.	Shiratori M, Nagashima I, Takada T, et al. Successful treatment of ruptured hepatocellular carcinoma with intraperitoneal injection of OK432 [J]. J Hepatobiliary Pancreat Surg, 2004, 11(6): 426429.

1. 夏锋. 肝癌的分子分型与肝癌的诊治 [J]. 实用临床医药杂志, 2010, 14(13): 12.
2. Globocan 2008 (IARC). Liver cancer incidence and mortality worldwide in 2008 summary [EB/OL]. http://globocan.iarc.fr/factsheets/cancers/liver.asp.
3. Battula N, Madanur M, Priest O, et al. Spontaneous rupture of hepatocellular carcinoma: a Western experience [J]. Am J Surg, 2009, 197(2): 164167.
4. Miyamoto M, Sudo T, Kuyama T. Spontaneous rupture of hepatocellular carcinoma: a review of 172 Japanese cases [J]. Am J Gastroenterol, 1991, 86(1): 6771.
5. Tanaka A, Takeda R, Mukaihara S, et al. Treatment of ruptured hepatocellular carcinoma [J]. Int J Clin Oncol, 2001, 6(6): 291295.
6. Kew MC, Hodkinson J. Rupture of hepatocellular carcinoma as a result of blunt abdominal trauma [J]. Am J Gastroenterol, 1991, 86(8): 10831085.
7. Hermann RE, David TE. Spontaneous rupture of the liver caused by hepatomas [J]. Surgery, 1973, 74(5): 715719.
8. Nagasue N, Inokuchi K, Kobayashi M, et al. Hepatoportal arteriovenous fistula in primary carcinoma of the liver [J]. Surg Gynecol Obstet, 1977, 145(4): 504508.
9. Kanematsu M, Imaeda T, Yamawaki Y, et al. Rupture of hepatocellular carcinoma: predictive value of CT findings [J]. AJR Am J Roentgenol, 1992, 158(6): 12471250.
10. Zhu LX, Geng XP, Fan ST. Spontaneous rupture of hepatocellular carcinoma and vascular injury [J]. Arch Surg, 2001, 136(6): 682687.
11. Zhu LX, Liu Y, Fan ST. Ultrastructural study of the vascular endothelium of patients with spontaneous rupture of hepatocellular carcinoma [J]. Asian J Surg, 2002, 25(2): 157162.
12. Zhu LX, Meng XL, Fan ST. Elasticity of small artery in patient with spontaneous rupture of hepatocellular carcinoma [J]. Hepatol Res, 2004, 29(1): 1317.
13. 朱立新, 耿小平, 范上达. 肝癌自发性破裂病因探讨 [J]. 中华外科杂志, 2004, 42(17): 10361039.
14. 朱立新, 耿小平, 范上达. 肝癌自发性破裂患者血管超微结构研究 [J]. 中华外科杂志, 2006, 44(3): 161164.
15. 吕成超, 朱立新. 肝癌自发性破裂机理的研究进展 [J]. 中国普外基础与临床杂志, 2006, 13(2): 181183.
16. 马连峰. 原发性肝癌自发性破裂出血误诊分析 [J]. 河南肿瘤学杂志, 2003, 16(1): 3333.
17. Vergara V, Muratore A, Bouzari H, et al. Spontaneous rupture of hepatocelluar carcinoma: surgical resection and longterm survival [J]. Eur J Surg Oncol, 2000, 26(8): 770772.
18. Yeh CN, Lee WC, Jeng LB, et al. Spontaneous tumour rupture and prognosis in patients with hepatocellular carcinoma [J]. Br J Surg, 2002, 89(9): 11251129.
19. Kim PT, Su JC, Buczkowski AK, et al. Computed tomography and angiographic interventional features of ruptured hepatocellular carcinoma: pictorial essay [J]. Can Assoc Radiol J, 2006, 57(3): 159168.
20. Kung CT, Liu BM, Ng SH, et al. Transcatheter arterial embolization in the emergency department for hemodynamic instability due to ruptured hepatocellular carcinoma: analysis of 167 cases [J]. AJR Am J Roentgenol, 2008, 191(6): W231W239.
21. Lai EC, Lau WY. Spontaneous rupture of hepatocellular carcinoma: a systematic review [J]. Arch Surg, 2006, 141(2): 191198.
22. Kirikoshi H, Saito S, Yoneda M, et al. Outcomes and factors influencing survival in cirrhotic cases with spontaneous rupture of hepatocellular carcinoma: a multicenter study [J]. BMC Gastroenterol, 2009, 9: 29.
23. 朱光辉, 翁杰锋, 温敏杰. 急诊手术治疗原发性肝癌破裂出血的临床分析 [J]. 实用医学杂志, 2008, 24(19): 33893390.
24. 汪建成, 胡道予, 姚洪亮, 等. 原发性肝癌自发性破裂出血介入动脉栓塞治疗 [J]. 中国癌症杂志, 2005, 15(3): 285287.
25. 辜斌, 李小松. 肝癌破裂出血的肝动脉栓塞治疗 [J]. 实用临床医学, 2008, 9(10): 4143.
26. 曾俊仁, 向述天, 徐松, 等. 肝癌破裂出血介入栓塞治疗疗效分析 [J]. 当代医学, 2009, 15(29): 572573.
27. 王旭. 肝动脉化疗栓塞术治疗肝癌破裂出血的临床价值 [J]. 中国现代普通外科进展, 2008, 11(6): 546547.
28. 张贵德, 姜成文, 宋希江. 肝动脉栓塞治疗26例原发性肝癌自发性破裂出血 [J]. 中国肿瘤临床, 2007, 34(14): 833834.
29. 孟环. 急诊介入治疗肝癌破裂出血 [J]. 临床医学, 2008, 28(12): 8283.
30. 范永斌, 孙思敬. 原发性肝癌自发破裂出血的外科治疗 [J]. 中国现代普通外科进展, 2008, 11(5): 440441.
31. Caruso DM, Battistella FD, Owings JT, et al. Perihepatic packing of major liver injuries: complications and mortality [J]. Arch Surg, 1999, 134(9): 958962.
32. 田建明, 王飞, 叶华, 等. 肝癌的规则性、变异性供血及其临床意义 [J]. 中华放射学杂志, 1994, 28(2): 9396.
33. 罗志强, 汪家珠, 庄阳辉, 等. 原发性肝癌自发破裂出血的手术治疗(附28例报告) [J]. 中华肝胆外科杂志, 2005, 11(3): 205206.
34. 肖玉根, 杨清水. 手术治疗肝癌破裂出血32例 [J]. 中国医药, 2006, 1(8): 476477.
35. 吴安任. 手术治疗原发性肝癌并发破裂出血的生存分析 [J]. 医学信息, 2009, 22(7): 12631265.
36. 韩国秀, 王刚. 原发性肝癌破裂出血18例手术治疗体会 [J]. 河南外科学杂志, 2009, 15(1): 60.
37. 尹修才, 董建伟, 李新成. 肝癌破裂出血21例外科处理体会 [J]. 中国当代医药, 2010, 17(1): 144.
38. 蔡海. 原发性肝癌自发性破裂出血的特点和治疗分析 [J]. 肝胆外科杂志, 2007, 15(3): 186188.
39. 许建伟, 赵文娟. 原发性肝癌自发性破裂出血的临床分析 [J]. 南京医科大学学报(自然科学版), 2007, 27(11): 13391340.
40. 李志壮, 曲新国, 宋秀玲. 原发性肝癌破裂出血的外科处理 [J]. 中国医药导报, 2008, 5(19): 125.
41. 姚少清. 原发性肝癌自发性破裂出血临床观察 [J]. 中华实用诊断与治疗杂志, 2008, 22(12): 941942.
42. 陈凌岩, 王伟, 陈骥, 等. 原发性肝癌自发性破裂外科治疗81例分析 [J]. 中华普外科手术学杂志(电子版), 2010, 4(2): 193195.
43. Buczkowski AK, Kim PT, Ho SG, et al. Multidisciplinary management of ruptured hepatocellular carcinoma [J]. J Gastrointest Surg, 2006, 10(3): 379386.
44. Chiappa A, Zbar A, Audisio RA, et al. Emergency liver resection for ruptured hepatocellular carcinoma complicating cirrhosis [J]. Hepatogastroenterology, 1999, 46(26): 11451150.
45. 徐海燕. 原发性肝癌自发性破裂出血治疗分析 [D]. 长沙: 中南大学, 2010: 141.
46. 贺强, 陈大志, 郎韧, 等. 急诊肝移植治疗暴发性肝功能衰竭四例 [J]. 中华器官移植杂志, 2005, 26(5): 289291.
47. 傅仁勇, 董昕, 刘祝. 原发性肝癌破裂出血的急诊治疗策略 [J]. 腹部外科, 2005, 18(4): 218219.
48. Ng KK, Lam CM, Poon RT, et al. Radiofrequency ablation as a salvage procedure for ruptured hepatocellular carcinoma [J]. Hepatogastroenterology, 2003, 50(53): 16411643.
49. Kobayashi M, Ikeda K, Hosaka T, et al. Successful control of ruptured hepatocellular carcinoma with radiofrequency ablation [J]. J Gastroenterol, 2004, 39(2): 192193.
50. Fuchizaki U, Miyamori H, Kitagawa S, et al. Radiofrequency ablation for lifethreatening ruptured hepatocellular carcinoma [J]. J Hepatol, 2004, 40(2): 354355.
51. Manikam J, Mahadeva S, Goh KL, et al. Percutaneous, nonoperative radio frequency ablation for haemostasis of ruptured hepatocellular carcinoma [J]. Hepatogastroenterology, 2009, 56(89): 227230.
52. Shiratori M, Nagashima I, Takada T, et al. Successful treatment of ruptured hepatocellular carcinoma with intraperitoneal injection of OK432 [J]. J Hepatobiliary Pancreat Surg, 2004, 11(6): 426429.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Diagnosis and Treatment for Spontaneous Rupture of Hepatocellular Carcinoma

Abstract Full text Figures/Tables Video References Cited by

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