探讨原发性肝癌（PLC）自发性破裂出血急诊经导管动脉化疗栓塞（TACE）术后的近远期预后及影响因素。

回顾性分析2017年1月至2019年12月行急诊TACE术的96例PLC自发性破裂出血患者的临床资料，根据术后1年内生存状况分为预后不良组（n=45）和预后良好组（n=51）。采用SPSS 25.0统计学软件分析数据，定性资料以[例(%)]表示，采用χ²检验；定量资料均呈正态分布，以（）表示，采用独立样本t检验；采用多因素COX回归分析患者预后的独立影响因素；采用受试者工作特征（ROC）曲线的曲线下面积（AUC）来评估参数对患者术后1年内死亡的预测价值。P<0.05为差异有统计学意义。

全部患者均完成急诊TACE术，短期止血成功率为91.7%，中位生存时间为10.9个月，术后1年的生存率为46.9%（45/96）。预后不良组患者的年龄、Child-Pugh分级、TNM分期、合并门静脉癌栓的比例、癌灶最大径、凝血酶原时间、总胆红素、谷丙转氨酶、肌酐、甲胎蛋白水平显著高于预后良好组，血红蛋白（HB）水平、预后营养指数（PNI）显著低于预后良好组（P<0.05）。多因素COX回归分析结果表明Child-Pugh分级、TNM分期、术前HB水平、PNI是急诊TACE预后的独立影响因素（P<0.05）。ROC曲线分析结果表明急诊TACE术前HB水平、PNI对患者术后1年内死亡具有较高的预测价值（P<0.05）。

PLC自发性破裂出血行急诊TACE术的短期止血疗效较好，Child-Pugh分级、TNM分期、术前HB水平、PNI是患者预后的独立影响因素。

To analyze the short-term and long-term prognosis and influencing factors of primary liver cancer (PLC) with spontaneous ruptured hemorrhage after emergency transcatheter arterial chemoembolization (TACE) surgery.

Clinical data of 96 PLC patients with spontaneous ruptured hemorrhage underwent emergency TACE surgery from January 2017 to December 2019 were retrospectively analyzed, and they were included in this study and divided into poor prognosis group (n=45) and good prognosis group (n=51) based on one-year survival status after surgery. Statistical analysis were performed by using SPSS 25.0 software. Count data were expressed as [Example (%)] and were examined by using χ2 test ; Measurement data exhibiting a normal distribution, were represented by (), and were exmined by using independent sample t test. By using multiple factor COX regression analysis was performed to identify independent prognostic factors of patients. Furthermore, the area under the curve (AUC) of the receiver operating characteristic (ROC) curve were used to evaluate the predictive value of the mortality of patients within 1 year after surgery. P <0.05 was considered as a statistically significant difference.

All patients completed emergency TACE surgery, with a short-term hemostasis success rate of 91.7%. The median survival time of all patients was 10.9 months, and the one-year survival rate after surgery was 46.9% (45/96). Age, the proportions of Child Pugh grade C, TNM stage IV, portal vein tumor thrombus, the maximum diameter of cancer focus, blood levels of prothrombin time, total bilirubin, glutamic transaminase, creatinine and alpha-fetoprotein in poor prognosis group were significantly higher than those in the good prognosis group, and the blood level of hemoglobin (HB) and prognostic nutritional index (PNI) were significantly lower than those in the good prognosis group (P<0.05). The multivariate COX regression analysis result showed that Child Pugh grade, TNM stage, preoperative Hb and PNI were the independent influencing factors for the prognosis of patients after emergency TACE surgery (P<0.05). The ROC curve analysis result indicated that Hb and PNI before emergency TACE have high predictive value for mortality within one-year after surgery (P<0.05).

The short-term hemostatic effect of emergency TACE for PLC patients with spontaneous ruptured hemorrhage is good, and Child Pugh grade, TNM stage, preoperative Hb and PNI were the independent influencing factors for postoperative prognosis of patients.