| Primary liver cancer(PLC),as the fifth largest malignant tumor in the world,and the third place in the tumor related cause of death,has become an important disease that threatens human health.Spontaneous rupture bleeding is one of the fatal complication of primary liver cancer in patients with primary liver cancer incidence is 3% ~ 15%,30 days case fatality rate is as high as 31% ~ 67%,9% ~ 10% of patients with primary liver cancer deaths,and bleeding rate is as high as 43%.Spontaneous rupture of primary liver cancer is characterized by rapid onset,rapid progression,high risk of rehemorrhage,high mortality,metastasis of potential abdominal cavity,and poor prognosis,etc.Although the medical technology is developing continuously,and the research on it is gradually deepening,but the diagnosis and treatment of this complication is still a huge challenge,and it faces many difficulties in the diagnosis and treatment process.It is still the key and difficult point in clinical work how to make a rapid and clear diagnosis,both effective hemostasis and comprehensive treatment of tumor.There are many reasons for the rupture of hepatocellular carcinoma,including single factor and multiple factors,which are related to the following factors:(1)Hepatocellular carcinoma(HCC)is a rich blood supply tumor.And there are defects prone to rupture and bleeding in the process of tumor angiogenesis.(2)The tumor was rapidly growing,and the infection caused by ischemia and necrosis in the tumor was ruptured.(3)The tumor erodes the blood vessels directly.(4)The tumor is located on the edge of the liver,protrudes from the surface of the liver,and the tumor invades the capsule.It can cause bleeding easily when external forces or abdominal pressure increase.(5)The coagulation function of patients with cirrhosis is poor.Hemorrhage of hepatocellular carcinoma is one of the serious life-threatening complications.And if there is not active rescue,there will have high mortality and poor prognosis.The key to treatment is to actively and effectively hemostasis,and should actively seek surgical removal of the tumor.Hepatectomy is the only treatment that has the hope of eradicating bleeding from the PLC.Tumor progression,abdominal cavity and distant metastasis risk increased after the rupture of liver cancer,so emergency hepatectomy was performed in the case of strict surgical indications.For patients who are unable to perform emergency surgery,TAE may be the preferred treatment for phase I hemostasis,creating favorable conditions for stage II hepatectomy.If the patient is not satisfied with TAE treatment,he or she should actively choose conservative treatment,palliative surgery and other treatment methods.Ruptured liver cancer with hemorrhage after surgery is focused on the prevention and treatment of abdominal planting transfer early found early treatment,namely in the operative treatment of ruptured liver cancer with hemorrhage consciously prevent abdominal planting in the process of metastasis.(1)Intraoperative patients should strictly follow the no-tumor principle.(2)During perioperative period,transfusion of foreign blood should be avoided.(3)Intraoperative chemotherapeutic drug retention or postoperative enhancement chemotherapy and other further treatment.The therapeutic effect of abdominal implant metastasis is far better than that of patients with advanced liver cancer,and the treatment effect of the retroperitoneal implant transfer is poor in most patients. |
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