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1、1Surgical management of spontaneous rupture of primary liver cell carcinoma: a case report作者：Alese O.B.1, Irabor D.O.2【摘要 】 Primary liver cell carcinoma (PLCC) or Hepatocellular carcinoma (HCC) is the most common primary malignant liver tumor in Nigeria. It is a difficult problem in surgery for the
2、diagnosis and therapy of spontaneous liver rupture. The clinical presentation can be varied owing to its clinical signs being usually not specific; therefore, correct diagnosis and management are very important. Without any treatment, the outcome is poor and survival rate is only 10%. Surgeons opera
3、te on those patients who present with ruptured PLCC; consisting of packing, hepatic artery ligation and hepatectomy. However, it is often associated with a high mortality rate; as high as 70%, even for the less invasive procedures like packing, argon beam coagulation or hepatic artery ligation. We p
4、resent a 24year old lady who had ligation of hepatic artery at an emergency laparotomy for ruptured primary liver cell carcinoma. 2【关键词】 Primary liver cell carcinoma; Spontaneous liver rupture; Emergency Laparotomy; Ligation of hepatic artery; Hepatectomy.Introduction:Primary liver cell carcinoma (P
5、LCC) or Hepatocellular carcinoma (HCC) is not an uncommon disease in Nigeria. It is the most common primary malignant liver tumor1. Worldwide annual incidence of PLCC was estimated to be at least one million new patients2, whilst its incidence of spontaneous rupture was about 10%3, 4. The clinical p
6、resentation of PLCC can be varied owing to its clinical signs being usually not specific. Therefore, correct diagnosis and management are very important to prevent invariable mortality from spontaneous rupture of a cancer nodule. At present, it is a difficult problem in surgery for the diagnosis and
7、 therapy of spontaneous liver rupture, especially in resourceconstrained economies.Despite the advance in surgical technology, the 3management of ruptured PLCC is still a challenge to surgeons. Moreover, there has been no randomized control study published on this aspect. The exceptionally good outc
8、ome of emergency hepatectomy for ruptured PLCC in some centers may be the result of selection bias. This paper reports on the operative management of a female patient who had hepatic artery ligation for spontaneous rupture of PLCC, and subsequent relevant discussion of the topic.Case Presentation:We
9、 present a 24year old female who had an emergency laparotomy via a transverse suprapubic incision, on the 31st of May 2006, based on a preoperative diagnosis of ruptured ectopic pregnancy. She was brought into the hospital on account of sudden loss of consciousness five hours prior to presentation,
10、while running an errand. There was no history of seizure, urinary or faecal incontinence, antecedent trauma or bleeding from the orifices. History of sexual exposure could not be ascertained. Her last menstrual period was said to have been some time in the previous month.4Examination revealed a youn
11、g lady who was unconscious, markedly pale, not febrile nor jaundiced. Glasgow coma scale (GCS) score was 3/15. The abdomen was distended, but moved with respiration. She had hepatomegaly of 8cm below the right lower coastal margin. Percussion notes were dull. Abdominal paracentesis yielded non clott
12、ing blood. Vaginal examination yielded a bulging pouch of Douglas.The packed cell volume was 16%, whilst the random blood sugar was 121mg/dl. Urinalysis, Liver function tests, Serum electrolytes and urea were normal Intraoperative findings were 3.5 liters of haemoperitoneum, with normal genitourinar
13、y system. The anterior surface of the liver was nodular, with bleeding from one of the nodules measuring 10cm in its widest diameter, located across segments IV, V and VIII. There were satellite nodules on the diaphragmatic surface of the liver. There were no enlarged regional lymph nodes. We were t
14、hus called by the Gynecologists to join the operation.The hepatic artery was ligated with No.1 silk suture, at the free edge of the foramen of Winslow. The bleeding resolved 5after the ligation. An incisional biopsy of one of the hepatic masses was sent for histology: primary liver cell carcinoma wi
15、th background cirrhosis. She was transfused with five units of blood.She made an uneventful post operative recovery. Chest xray was normal. Liver function tests revealed mildly elevated liver enzymes. An abdominopelvic ultrasound scan done on the first day postoperative showed that the liver was enl
16、arged with a span of 21.8 cm.There was a relatively large hypoechoic mass in the posteriorinferior portion of the right lobe adjacent to the gall bladder and extending to the left lobe. The mass compressed the inferior vena cava. Doppler color flow showed that the mass was relatively hypovascular. All other abdominal organs were normal.She was discharged home after her stitches were removed on the 9th day to be seen in the surgical outpatient clinic. Abdominal ul
