다량의 복강 내 출혈을 동반한 파열된 간세포암 : 간동맥색전술로 치료한 환자에서의 예후인자의 다중인자분석 A Multivariate Analysis of Prognostic Factors in Patients Treated with Hepatic Arterial Embolization = Ruptured Hepatocellular Carcinoma with Massive Intraperitoneal Hemorrhage

다국어 초록 (Multilingual Abstract)

Purpose : TO evaluate the safety and effectiveness of transarterial oily chemoembolization(TOCE) or transarterial Gelfoam embolization(TGE) for ruptured hepatocellular carcinoma(HCC) with massive intraperitoneal hemorrhage and to describe the most important prognostic factors of the emergency embolization.
Materials and Methods : Fifty-dight consecutive patients with spontaneous rupture of HCC underwent emergency TOCE(n=28) or TGE(n=30). In TOCE group, we used infusion of lipiodol(3-10cc), adriamycin(20-50㎎), and mitomycin(2-10㎎) and followed by blockade of the hepatic arterial flow with gelatin sponge particles. In TGE group, patients received only Gelfoam embolization. The survival time was estimated from the time of the embolization by the Kaplan-Meier Method and to analyze prognostic factors, the Cox's proportional hazard regression model was used.
Reuslts : Successful hemostasis was achieved in 56 patients(97%). The mean survival was 222 days in these patients. Eleven of 41 patients died of hepatic failure ; six ere in TOCE group(21%) and five in TGE group(17%). Two factors proved to significantly influenced prognosis(P<0.05) ; portal vein involvement by the tumor had the most important prognostic significance followed by higher serum total bilirubin level greater than 3.0㎎/㎗.
Conclusion : Although TOCE and TGE effectively controlled the hemorrhage from the ruptured HCC, they carry a high risk of hepatic failure. In addition, tumor thrombus in the major portal vein branch and high serum total bilirubin level were the most important factor for survival.