Bleeding primary liver cancer, liver cancer patients is a serious and deadly complications, the incidence rate of about 5.46% -19.8% of patients with liver cancer is the main cause of death, accounting for 9% of HCC death -10% in HCC causes of death for the 4. Since the pathogenesis of a sudden, sharp, shock and frequently, so their treatment difficulties, poor prognosis, if not active treatment, most patients died quickly.

1, the mechanism

Bleeding liver cancer was particularly prevalent in the nodular type and massive hepatocellular carcinoma, particularly associated with liver cirrhosis, liver cancer rare diffuse. HCC bleeding two types: one for subcapsular liver bleeding, a person is pierced into the peritoneal envelope, the rapid progress in the latter condition, the mortality rate high.

One, liver growth in the process of expansion of the growth, the higher the pressure within the tumor, but because of rapid tumor growth,

A relative shortage of blood for ischemia and hypoxia, tumor necrosis central liquefaction, corrosion vessels in tumor congestion, and high internal pressure necrosis, based on deep breaths, stand up, vibration, severe cough, or forced medical examinations and defecation increased intra-abdominal pressure of circumstances, the pressure of the surrounding envelope breakthrough tumor weak or normal liver tissue rupture, resulting in abdominal bleeding.

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

When the portal increased pressure, arterial and venous pressure in the increased gradually to the vascular wall thinning, leading to bleeding.肝癌破裂出血患者常合并有肝硬化，并发率高达90%以上，较无破裂出血肝癌患者肝硬化并发率高。

3, tumor necrosis infection after liquefaction erosion vascular tumor growth bleeding HCC is an important factor.

4, liver accompanied cirrhosis, liver dysfunction, abnormal clotting mechanism, HCC is one of the reasons for bleeding.

Two clinical performance

(1) the general performance of liver cancer

Hepatomegaly, liver pain. Abdominal varices, weight loss, low heat, jaundice, elevated serum AFP, the former suffering from some bleeding in liver cancer diagnosed before the liver, or is receiving treatment, a small portion of the bleeding as the first symptom.

(2) performance of bleeding

Subcapsular liver bleeding, liver performance for the sudden pain, right upper quadrant mass increases rapidly. The liver tenderness and tension, North Korea fertilizer, with nausea, vomiting, was pale, a cold sweat, dizziness, palpitations, accelerated pulse, blood pressure and blood volume decline inadequate performance, ruptured liver cancer if smaller, the slow bleeding, blood volume can be no less than the performance of the liver or only minor limitations pain, 3 - 5 days to ease; HCC ruptured capsule pierced into the peritoneal people, showed sudden abdominal pain, and then reduce pain, and spread to the entire abdomen, accompanied by bleeding and acute peritonitis performance, such as abdominal pain, bloating, nausea, vomiting, was pale, a cold sweat, pulse accelerated, abdominal tension, mobility Voiced positive, the patient quickly into shock. Severe abdominal pain occurred in 54% -100%, the incidence of shock by 17% -100%, peritoneal irritation up to 92%.

3, diagnosis

The diagnosis of the disease generally is not difficult, especially liver cancer diagnosis has been clear and greater amount of bleeding. If less bleeding, the diagnosis is more difficult, with a history of liver cancer patients with cirrhosis, or the sudden appearance of strength after right upper quadrant pain or hemorrhagic shock and diffuse peritonitis performance should be alert of the disease possible. The diagnosis of abdominal wear, CT, B ultrasonic examination, especially for the diagnosis of abdominal wear on the larger significance in the diagnosis and therefore, for unexplained abdominal pain, bloating, peritoneal irritation, abdominal diagnosis should be wearing. The diagnosis of liver cancer patients have not yet clear, sudden onset of abdominal distention, abdominal pain associated with peritoneal irritation and shock performance, and should be abdominal ultrasound, CT and angiography in the diagnosis of abdominal and wear and checks to clear whether intrahepatic lesions and liver cancer bleeding. The diagnosis of the disease can make reference to the following diagnostic criteria:

A, a serious liver dysfunction performance AFP positive.

2, abdominal not out of the blood coagulation, the positive rate of 100%, peritoneal fluid puncture AFP bile analysis of amylase, or check cell positive performance.

3, decreased hemoglobin levels, often 90 g / L.

4, ultrasound, CT and angiography hepatic artery rupture can be found in tumors, abdominal hemorrhage.

4, treatment

Neoplasms bleeding often sharp, dangerous and required immediate treatment, or a stable condition after active consideration for primary liver lesion treatment.

(1) Non-Surgical Treatment

An emergency handling less amount of bleeding. Should sits flat rest, restricted activities, abdominal compression bandaging, the amount of bleeding, lose peripheral blood circulatory failure patients should be timely in blood pressure, pulse, respiration, heart rate and he was closely monitoring the situation and anti-shock therapy.