The treatment of liver cancer bleeding

Bleeding primary liver cancer, liver cancer patients is a serious and deadly complications, the rate of about 5.46% -19.8% of patients with liver cancer is the leading cause of death of liver cancer death of the 9 % -10% In liver cancer in the cause of death for the first four. As the disease of a sudden, sharp, shock and frequently, the difficulties of their treatment, prognosis is poor, if not positive where most of the patients died quickly.

First, the mechanism

Bleeding more common in liver cancer nodules and massive hepatocellular carcinoma, particularly those associated with liver cirrhosis, liver cancer rare diffuse. HCC bleeding There are two types: a hemorrhage of the liver capsule, the capsule into a person for abdominal perforation, the rapid progress in the latter condition, the high mortality rate.

1, liver in the process of growth due to expansion of growth, the higher the pressure within the tumor, and because of the rapid tumor growth,

Blood for a relative shortage of ischemia and hypoxia, tumor necrosis central liquefaction, corrosion vessels in tumors congestion, pressure is high and on the basis of necrosis, in deep breaths, stand up, shock, severe coughing, defecation or physical force, such as increased intra-abdominal pressure The circumstances, the pressure of the surrounding capsule breakthrough in cancer or normal liver tissue breakdown of the weak, resulting in intra-abdominal bleeding.

2, liver cirrhosis portal hypertension is the peripheral venous system tumor blood supply, and the portal and hepatic veins are traffic-related.

When the portal pressure increased, arteries and veins, the pressure increased, so that gradually thinning vessel walls, leading to bleeding. Bleeding in patients with liver cancer often associated with cirrhosis, with rates as high as 90 percent, less bleeding liver cancer patients with high rate of liver cirrhosis.

3, tumor necrosis of tumor growth after the liquefied erosion damage blood vessels rupture of the liver cancer is also an important factor.

4, liver accompanied cirrhosis, liver damage, abnormal clotting mechanisms, liver cancer is one of the reasons for bleeding.

Second, clinical performance

(A) the general performance of liver cancer

Hepatomegaly, liver pain. Abdominal wall varicose veins, weight loss, fever, jaundice, such as elevated serum AFP, some suffering from liver cancer before the bleeding before the diagnosis of liver cancer, or are receiving treatment, some with less bleeding as the first symptom.

(B) performance of bleeding

Subcapsular liver bleeding, showed sudden liver pain, right upper quadrant mass rapid increase. Liver tenderness and tension, North Korea, such as fertilizer, can be associated with nausea, vomiting, looking pale and a cold sweat, dizziness, palpitations, to speed up the pulse, blood pressure, such as blood volume declined less than the performance of smaller rupture if liver cancer, bleeding slowly, Blood volume can be no shortage of performance, or only minor pain liver limitations, 3-5 days to ease; liver cancer were broken into the abdominal perforation capsule, showed sudden abdominal pain, and then reduce the pain And spread to the entire abdomen, accompanied by acute peritonitis and the performance of bleeding, such as abdominal pain, abdominal distention, nausea, vomiting, looking pale and a cold sweat, to speed up the pulse, abdominal tension, mobility Zhuoyin positive, the patient quickly into shock状态. Severe abdominal pain rate was 54% -100%, the shock rate was 17% -100%, peritoneal irritation sign up to 92 percent.

Third, the diagnosis

The diagnosis of the disease in general it is not difficult, especially liver cancer diagnosis has been clear and the greater amount of bleeding. If less amount of bleeding, the diagnosis more difficult, have a history of liver cancer in patients with cirrhosis, or forced suddenly appeared after the right upper quadrant pain or hemorrhagic shock and diffuse peritonitis performance, should guard against the possibility of this disease. Diagnosis of abdominal wear, CT, B Chaodeng inspection, in particular the diagnosis of abdominal wear on the larger significance of the diagnosis, therefore, for unknown reasons the abdominal pain, abdominal distention, peritoneal irritation sign, should the diagnosis of abdominal wear line . The diagnosis of liver cancer patients have not yet clear, the sudden onset of abdominal distention, abdominal pain associated with peritoneal irritation sign and shock performance, should be held B-abdomen, CT, diagnostic angiography and abdominal wear such as checks to clear availability of liver Of liver cancer lesions and bleeding. The diagnosis of the disease may refer to the following diagnostic criteria:

1, a serious liver damage performance, AFP positive.

2, abdominal not out of the blood coagulation, the positive rate of 100 percent, AFP abdominal puncture of bile analysis of amylase, or check positive performance of cancer cells.

3, hemoglobin level of decline, often in the 90 g / L below.

4, B-chao, CT hepatic artery was performed and found that tumors can rupture, abdominal bleeding.

4, treatment

Neoplasms bleeding often sharp, dangerous, the need for immediate rescue, or stable condition after the liver should be actively considered for the treatment of primary lesions.

(A) non-surgical treatment

1, emergency handling lesser amount of bleeding. Should rest sits flat, restrictions on activities, Fudai compression bandaging, the amount of bleeding, failed bloody cycle of failure around the time the patient should be in blood pressure, pulse, breathing, heart rate and consciousness conducted intensive care and anti-shock therapy.
2, added a smaller blood volume bleeding can only add to the liquid crystal, the amount of bleeding, lose blood circulation around the failure of patients to be timely infusion of new blood or blood components.

(B) surgical treatment

The condition of dangerous, high mortality, all with surgical operation indications should be treated immediately.

Surgical indications:

(1) of the general situation is good, the age of 60 years;

(2) expressly for liver cancer bleeding, with shock, short-term hemoglobin rapidly declining;

(3) can not rule out other causes bleeding, or other acute abdomen need surgical exploration;

(4) compensatory liver function is good, especially hepatic encephalopathy. Massive ascites, or other important organ dysfunction, it is estimated that tumors can be removed or other effective treatment.

(B) TCM treatment

The disease Jizhou, dangerous conditions and high mortality, the use of Chinese medicine treatment is still rare.
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