探讨巨大肝细胞癌（肝癌）破裂出血转化切除策略。

回顾性分析2018年11月南方医科大学附属珠江医院收治的1例巨大肝癌破裂出血患者临床资料。患者男，56岁，因右上腹隐痛2周入院。既往有乙型病毒性肝炎病史20余年。体检：上腹膨隆，右上腹触及肿物，下缘达肋下三指。AFP 3 433 μg/L。CT检查示：肝左内叶内可见大块低密度影。初步诊断：原发性肝癌。患者签署知情同意书，符合医学伦理学规定。观察患者诊疗策略和疗效。

入院后发生肝癌破裂，急诊行经导管血管栓塞术（TAE）治疗。然后予TACE +分子靶向药物降期转化治疗3个月。TAE术后16周采用三维可视化技术评估发现肿瘤明显缩小，遂行肝癌切除术，将肝左叶肿瘤完整切除，肝右叶肿瘤在术中超声引导下采用Habib射频消融。术后病理诊断为G2期肝细胞癌，未见脉管和神经侵犯。术后改服仑伐替尼，并辅以槐耳颗粒。截止投稿日期，患者存活超23个月。

巨大肝癌破裂出血患者采用TAE联合分子靶向药物等多种治疗方式，肿瘤转化降期后二期手术切除，仍可改善生存质量。

To explore the transformational resection strategy for rupture and hemorrhage of giant hepatocellular carcinoma (HCC).

Clinical data of 1 patient with rupture and hemorrhage of giant HCC admitted to Zhujiang Hospital of Southern Medical University in November 2018 were retrospectively analyzed. The 56-year-old male patient was admitted to our hospital due to dull pain in the right upper abdomen for 2 weeks. A history of hepatitis B for over 20 years was noted. Upper abdominal swelling and a palpable mass in the right upper abdomen with the lower margin reaching three-finger away under the rib, were found in physical examination. The AFP level was 3 433 μg/L. A large low-density shadow could be seen in the left liver lobe by CT scan. The initially diagnosis was primary liver cancer. The informed consent of this patient was obtained and the local ethical committee approval was received. The diagnosis and treatment strategy and outcome were observed.

After admission, the rupture of tumor occurred. Transcatheter arterial embolization (TAE) was performed emergently. Subsequently, TACE combined with molecular targeted drug downstaging transformational therapy were given for 3 months. At 16 weeks after TAE, the tumors were found significantly reduced by three-dimensional visualization. Then, hepatectomy was performed. The tumors in the left lobe were completely resected. The tumors in the right lobe were ablated by intraoperative ultrasound-guided Habib radiofrequency. Postoperative pathological examination confirmed the diagnosis of stage G2 HCC, no vascular or nerve invasion was observed. Postoperatively, the patient was given with lavatinib and Huaier granules. Until the submission date, the patient has survived for over 23 months.

TAE combined with molecular targeted drugs and other interventions are recommended for patients with rupture and hemorrhage of giant HCC. Secondary surgical resection after tumor transformational downstaging treatment can still improve the quality of life.