objective: spontaneous hepatic tumor hemorrhage is a rare but challenging emergency especially among cirrhotic patients with poor hepatic function. this study aimed at analyzing the safety, efficacy and feasibility of transcatheter arterial embolization (tae) in the treatment of hepatic tumor hemorrhage.
methods: this retrospective study included all patients undergoing embolization attempt for hepatic tumor hemorrhage in the helsinki university hospital during 2004–2017. electronic medical records provided the study data. outcomes included the 30-day rebleeding, complication and mortality rates, need for blood transfusions, durations of intensive care unit and hospital admissions, estimates of overall survival, and analysis of factors associated with 30-day mortality.
results: during the study period, 49 patients underwent angiography for hepatic tumor hemorrhage. tae was technically feasible in 45 patients (92%), and controlled the bleeding with the first attempt in 84%. the 30-day complication and mortality rates were 57 and 33%, respectively. major complications occurred in 33% of patients. in-hospital mortality was higher among cirrhotic than non-cirrhotic patients (55 versus 7%, p<.001). patients with bleeding hepatic metastases, but no cirrhosis, had an in-hospital mortality of 0% with no major complications. patients with benign etiology had a good prognosis and no bleeding- or tumor-related mortality.
结果：在研究期间，49例患者接受了肝肿瘤出血血管造影检查。45例(92%)患者实施tae在技术上是可行的，84%的患者首次尝试tae即控制了出血。术后30天并发症发生率为57%，死亡率为33%。33%的患者出现严重并发症。肝硬化患者的住院死亡率高于非肝硬化患者(55% vs. 7%，p<.001)。无肝硬化的肝转移出血患者，住院死亡率为0%，且没有出现重大并发症。良性病因患者预后良好，无出血或肿瘤相关死亡。
discussion: tae is an effective method in controlling the bleeding in spontaneous hepatic hemorrhage. underlying pathology determines the prognosis that is poor especially in cirrhotic patients with bleeding hepatocellular carcinoma.讨论：tae是控制自发性肝出血的有效方法。基础病理决定了预后不良，尤其是在肝硬化出血的肝细胞癌患者中。