Treatment and Prognosis of Ruptured Hepatocellular Carcinoma

Kunihide Izawa*, Tohru Segawa, Tomeo Kadohara, Tohru Iwata, Masayuki Yamamoto, Takashi Yatsugi, Makoto Sasaki, Teiji Matsumoto, Toshifumi Eto, Koichi Motoshima, Tsukasa Tsunoda, Ryoichi Tsuchiya

Emergency Department*, Second Department of Surgery, School of Medicine, Nagasaki University

Prognosis and clinicopathology of 18 patients treated for spontaneous ruptured hepatocellular carcinoma were studied. In 252 patients with hepatocellular carcinoma in our institution, the incidence was 7.1%. Of those patients 11 (61%) were in hemorrhagic shock on admission. Five patients underwent one-stage curative hepatic resections. One patient died during the operation death, but the post-operative survival periods of the other four patients were over one year. One patient has been alive for 7.25 years after the first operation. Six patients given conservative treatment were managed by partial hepatectomy or hemostatic suture of the ruptured lesion (3 patients), transcatheter arterial embolization (2 patients), and ligation of a branch of the hepatic artery (l patient). All patients had multiple lesions in both lobes. The longest survival time was 5 months and 18 days. There were seven patients who could not be treated for ruptured hepacocellular carcinoma becaue of poor general condition. The longest survival time was 2 months. There were statistically significant differences between the curative hapatic resection group and the other groups in the cholinesterase and platelet levels and prothrombin time at the time of admission. In conclusion, hepatic resection provides the only hope of long survival for patients with ruptured hepatocellular carcinoma, other than the extent of the disease.

Key words
ruptured hepatocellular carcinoma, hepatic resection for ruptured hepatocellular carcinoma, transcatheter arterial embolization for ruptured hepatocellular carcinoma, ligation of the right hepatic artery, hemorrhagic shock

Reprint requests
Kunihide Izawa The Second Department of Surgery, Nagasaki University School of Medicine
7-1 Sakamoto-machi, Nagasaki, 852 JAPAN

Accepted
July 10, 1990

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