Advances in the mechanisms, diagnosis, and treatment of spontaneous rupture of hepatocellular carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

DONG Yunfang , LIU Feng ,  CHEN Peng

First Division, Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming 650033, P. R. China;

Corresponding author：

CHEN Peng, Email: 2224084941@qq.com

Keywords：

spontaneous tumor rupture of hepatocellular carcinoma; mechanism; diagnosis and treatment; research progress

DOI：

10.7507/1007-9424.202501084

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To systematically review the clinical risk factors, mechanisms, diagnostic strategies, and therapeutic advances in spontaneous rupture of hepatocellular carcinoma (STRHCC), aiming to optimize clinical decision-making. Method A comprehensive analysis of recent literature on STRHCC was conducted to summarize the latest advancements in its epidemiological characteristics, risk factors, underlying mechanisms, diagnostic approaches, and treatment modalities. Results Risk factors for STRHCC included tumor diameter >5 cm, exophytic tumor growth, moderate-to-massive ascites, elevated AFP level, portal vein invasion, and chronic liver disease. The pathogenesis involved the following aspects.① Tumor-specific growth dynamics: rapid proliferation causing tissue destruction, vascular compression, and intratumoral ischemia-necrosis.② Tumor microenvironment alterations: chronic inflammation, thin-walled neovessels, hypoxia-induced matrix degradation increased the risk of STRHCC.③ Vascular injury: elastin degeneration, collagen degradation, immune complex deposition.④ Cirrhosis-related hemodynamic instability and tissue fragility. Diagnosis relied on clinical manifestations (acute abdominal pain, shock, intraperitoneal hemorrhage) and imaging: contrast-enhanced CT showed 100% accuracy for active bleeding detection, ultrasound aided screening, and MRI was used for stable patients. Treatment strategies encompassed conservative therapy, interventional procedures (hemostasis success rate: 53%–100%, preferred for hemodynamically unstable cases but risk hepatic failure in MELD ≥13 patients), emergency surgery (high mortality: 16.5%–100%), staged resection (transcatheter arterial embolization followed by elective surgery with 45% 5-year survival rate vs. 12-month median survival for conservative therapy), and radiofrequency ablation (limited evidence for hemostasis, safety/efficacy require further validation). Conclusions STRHCC is a life-threatening complication influenced by multifactorial risks and complex molecular mechanisms. Early identification of high-risk patients, combined interventional and staged surgical approaches, and personalized treatment are critical for improving outcomes. Future research should focus on elucidating molecular pathways and refining risk assessment models and integrated therapeutic strategies.

1.	姚一菲, 孙可欣, 郑荣寿. 《2022全球癌症统计报告》解读: 中国与全球对比. 中国普外基础与临床杂志, 2024, 31(7): 769-780.
2.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
3.	Zhou M, Wang H, Zeng X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet, 2019, 394(10204): 1145-1158.
4.	Samant H, Amiri HS, Zibari GB. Addressing the worldwide hepatocellular carcinoma: epidemiology, prevention and management. J Gastrointest Oncol, 2021, 12(Suppl 2): S361-S373.
5.	Zhang SY, Guo DZ, Zhang X, et al. Prognosis of spontaneously ruptured hepatocellular carcinoma: a propensity score matching study. J Cancer Res Clin Oncol, 2023, 149(11): 8889-8896.
6.	Huang X, Jia C, Xu L, et al. Survival of patients subjected to hepatectomy after spontaneous rupture of hepatocellular carcinoma: a meta-analysis of high-quality propensity score matching studies. Front Oncol, 2022, 12: 877091.
7.	Wang P, Moses AS, Li C, et al. Prognosis factors of predicting survival in spontaneously ruptured hepatocellular carcinoma. Hepatol Int, 2022, 16(6): 1330-1338.
8.	Sahu SK, Chawla YK, Dhiman RK, et al. Rupture of hepatocellular carcinoma: a review of literature. J Clin Exp Hepatol, 2019, 9(2): 245-256.
9.	Llovet JM, Kelley RK, Villanueva A, et al. Hepatocellular carcinoma. Nat Rev Dis Primers, 2021, 7(1): 6.
10.	Yoshida H, Mamada Y, Taniai N, et al. Spontaneous ruptured hepatocellular carcinoma. Hepatol Res, 2016, 46(1): 13-21.
11.	蒲俊. 原发性肝癌自发性破裂出血相关危险因素分析. 宁夏医科大学, 2020.
12.	张仙. 原发性肝癌自发性破裂出血的相关危险因素及高危中医证型的分析. 成都中医药大学, 2021.
13.	Chen Y, Guo D, Li X, et al. Predictors of spontaneous rupture of hepatocellular carcinoma and clinical outcomes following hepatectomy. Front Oncol, 2022, 12: 820867.
14.	Ye F, Ma D, Gong XY, et al. Development and validation of risk score for predicting spontaneous rupture of hepatocellular carcinoma. Ann Surg Treat Res, 2020, 99(5): 268-274.
15.	Ni Q, Jia H, Zhang Y, et al. Treatment and prognosis study of spontaneous rupture hemorrhage in hepatocellular carcinoma: recommendations for adding the A1 stage to the BCLC staging system. Cancer Med, 2024, 13(10): e6952.
16.	Dolapsakis C, Pavli P, Panagopoulos A, et al. Haemoperitoneum due to spontaneous rupture of a liver metastasis. Eur J Case Rep Intern Med, 2019, 6(7): 001142.
17.	Lally JSV, Ghoshal S, DePeralta DK, et al. Inhibition of Acetyl-CoA Carboxylase by phosphorylation or the inhibitor ND-654 suppresses lipogenesis and hepatocellular carcinoma. Cell Metab, 2019, 29(1): 174-182.
18.	Kim NS, Chun HR, Jung HI, et al. Spontaneous rupture of pyogenic liver abscess with subcapsular hemorrhage mimicking ruptured hepatocellular carcinoma: a case report. Medicine (Baltimore), 2021, 100(15): e25457.
19.	Cheng K, Cai N, Zhu J, et al. Tumor-associated macrophages in liver cancer: from mechanisms to therapy. Cancer Commun (Lond), 2022, 42(11): 1112-1140.
20.	Yang Q, Li X. Molecular network basis of invasive pituitary adenoma: a review. Front Endocrinol (Lausanne), 2019, 10: 7.
21.	曾俊莉, 袁冬梅, 刘红兵, 等. 血管正常化与肿瘤免疫治疗. 中国肺癌杂志, 2014, 17(3): 273-276.
22.	Rossaint J, Margraf A, Zarbock A. Perioperative inflammation. Anaesthesist, 2019, 68(7): 421-427.
23.	Zeng L, Zhu L, Fu S, et al. Mitochondrial dysfunction-molecular mechanisms and potential treatment approaches of hepatocellular carcinoma. Mol Cell Biochem, 2025, 480(4): 2131-2142.
24.	Fujita M, Yamaguchi R, Hasegawa T, et al. Classification of primary liver cancer with immunosuppression mechanisms and correlation with genomic alterations. EBioMedicine, 2020, 53: 102659.
25.	Liang N, Yang T, Huang Q, et al. Mechanism of cancer stemness maintenance in human liver cancer. Cell Death Dis, 2022, 13(4): 394.
26.	Xiao Y, Peng L, Xu H, et al. Mechanism of liver regeneration during ALPPS. Front Cell Dev Biol, 2022, 10: 916286.
27.	Zhu LX, Meng XL, Fan ST. Elasticity of small artery in patient with spontaneous rupture of hepatocellular carcinoma. Hepatol Res, 2004, 29(1): 13-17.
28.	Dezső K, Paku S, Kóbori L, et al. What makes cirrhosis irreversible?-Consideration on structural changes. Front Med (Lausanne), 2022, 9: 876293.
29.	Kaneko S, Asahina Y, Murakawa M, et al. Analysis of prognosis and background liver disease in non-advanced hepatocellular carcinoma in two decades. PLoS One, 2024, 19(3): e0297882.
30.	Battula N, Tsapralis D, Takhar A, et al. Aetio-pathogenesis and the management of spontaneous liver bleeding in the West: a 16-year single-centre experience. HPB (Oxford), 2012, 14(6): 382-389.
31.	Álvarez-García M, Otegui Martínez-Peñuela L, Calvo Hernández R, et al. Uncommon etiology of Cullen sign and Grey Turner sign. Rev Esp Enferm Dig, 2024, 116(5): 280.
32.	Kashiwadate T, Hara Y, Hashizume E, et al. A case of spontaneously ruptured hepatic angiosarcoma resected after transcatheter arterial embolization. J Surg Case Rep, 2022, 2022(9): rjac406.
33.	Lee HY, Hong SK, Hong SY, et al. Outcomes of living donor liver transplantation in patients with a history of ruptured hepatocellular carcinoma. Front Surg, 2021, 8: 722098.
34.	Zhu LX, Wang GS, Fan ST. Spontaneous rupture of hepatocellular carcinoma. Br J Surg, 1996, 83(5): 602-607.
35.	Kim PT, Su JC, Buczkowski AK, et al. Computed tomography and angiographic interventional features of ruptured hepatocellular carcinoma: pictorial essay. Can Assoc Radiol J, 2006, 57(3): 159-168.
36.	Darnis B, Rode A, Mohkam K, et al. Management of bleeding liver tumors. J Visc Surg, 2014, 151(5): 365-375.
37.	Péčová M, Benko J, Péč MJ, et al. A rare early-onset fatal complication after transarterial chemoembolization: a case report and review of the literature. Curr Oncol, 2024, 31(4): 1961-1970.
38.	Zhou J, Sun H, Wang Z, et al. Guidelines for the diagnosis and treatment of hepatocellular carcinoma (2019 edition). Liver Cancer, 2020, 9(6): 682-720.
39.	Xia F, Ndhlovu E, Zhang M, et al. Ruptured hepatocellular carcinoma: current status of research. Front Oncol, 2022, 12: 848903.
40.	Zhong F, Cheng XS, He K, et al. Treatment outcomes of spontaneous rupture of hepatocellular carcinoma with hemorrhagic shock: a multicenter study. Springerplus, 2016, 5(1): 1101.
41.	Hsueh KC, Fan HL, Chen TW, et al. Management of spontaneously ruptured hepatocellular carcinoma and hemoperitoneum manifested as acute abdomen in the emergency room. World J Surg, 2012, 36(11): 2670-2676.
42.	Liu CL, Fan ST, Lo CM, et al. Management of spontaneous rupture of hepatocellular carcinoma: single-center experience. J Clin Oncol, 2001, 19(17): 3725-3732.
43.	Chen CS, Ahn H, Shin JH, et al. Renal artery embolization for spontaneous hemorrhage in patients with acquired cystic kidney disease: a 20-year single-center experience. Pak J Med Sci, 2021, 37(4): 1111-1117.
44.	Okada N, Niimi K, Asami Y, et al. Retroperitoneal hematoma during prophylactic dose of heparin therapy for coronavirus disease 2019. Tokai J Exp Clin Med, 2023, 48(1): 47-51.
45.	Yan J, Li T, Deng M, et al. Ruptured hepatocellular carcinoma: what do interventional radiologists need to know? Front Oncol, 2022, 12: 927123.
46.	Zhu Q, Li J, Yan JJ, et al. Predictors and clinical outcomes for spontaneous rupture of hepatocellular carcinoma. World J Gastroenterol, 2012, 18(48): 7302-7307.
47.	Zou J, Li C, Chen Y, et al. Retrospective analysis of transcatheter arterial chemoembolization treatment for spontaneously ruptured hepatocellular carcinoma. Oncol Lett, 2019, 18(6): 6423-6430.
48.	Shinmura K, Choi YH, Shimohira M, et al. Comparison of conservative treatment versus transcatheter arterial embolisation for the treatment of spontaneously ruptured hepatocellular carcinoma. Pol J Radiol, 2018, 83: e311-e318.
49.	Marcacuzco Quinto A, Nutu OA, San Román Manso R, et al. Complications of transarterial chemoembolization (TACE) in the treatment of liver tumors. Cir Esp (Engl Ed), 2018, 96(9): 560-567.
50.	Kung CT, Liu BM, Ng SH, et al. Transcatheter arterial embolization in the emergency department for hemodynamic instability due to ruptured hepatocellular carcinoma: analysis of 167 cases. AJR Am J Roentgenol, 2008, 191(6): W231-W239.
51.	Shin BS, Park MH, Jeon GS. Outcome and prognostic factors of spontaneous ruptured hepatocellular carcinoma treated with transarterial embolization. Acta Radiol, 2011, 52(3): 331-335.
52.	Cheng YT, Teng W, Lui KW, et al. MELD score is the better predictor for 30-day mortality in patients with ruptured hepatocellular carcinoma treated by trans-arterial embolization. Am J Cancer Res, 2021, 11(7): 3726-3734.
53.	Zhang W, Huang Z, Che X. Emergency versus delayed hepatectomy following transarterial embolization in spontaneously ruptured hepatocellular carcinoma survivors: a systematic review and meta-analysis. World J Surg Oncol, 2022, 20(1): 365.
54.	段昌虎, 刘晓晨, 段建峰, 等. 肝癌破裂出血急诊TAE序贯手术切除联合腹腔热灌注化疗等综合治疗的研究分析. 肝脏, 2022, 27(4): 455-459.
55.	Xu X, Chen C, Liu Q, et al. A meta-analysis of TAE/TACE versus emergency surgery in the treatment of ruptured HCC. Cardiovasc Intervent Radiol, 2020, 43(9): 1263-1276.
56.	蔡重阳, 胡深, 赵金锋, 等. 肝切除手术时机对肝癌破裂出血治疗效果的影响. 中国医刊, 2020, 55(9): 954-957.
57.	赵亮. 原发性肝癌破裂出血一期切除与TACE后二期切除的疗效评估. 江汉大学, 2021.
58.	Yang H, Chen K, Wei Y, et al. Treatment of spontaneous ruptured hepatocellular carcinoma: a single-center study. Pak J Med Sci, 2014, 30(3): 472-476.
59.	Zhang FQ, Li L, Huang PC, et al. Transarterial embolization with hepatectomy for ruptured hepatocellular carcinoma: a meta-analysis. Minim Invasive Ther Allied Technol, 2022, 31(5): 676-683.
60.	Lai EC, Lau WY. Spontaneous rupture of hepatocellular carcinoma: a systematic review. Arch Surg, 2006, 141(2): 191-198.
61.	Kwon JH, Song GW, Hwang S, et al. Surgical outcomes of spontaneously ruptured hepatocellular carcinoma. J Gastrointest Surg, 2021, 25(4): 941-953.
62.	Marini P, Vilgrain V, Belghiti J. Management of spontaneous rupture of liver tumours. Dig Surg, 2002, 19(2): 109-113.
63.	Chen ZY, Qi QH, Dong ZL. Etiology and management of hemmorrhage in spontaneous liver rupture: a report of 70 cases. World J Gastroenterol, 2002, 8(6): 1063-1066.
64.	Tartaglia N, Di Lascia A, Cianci P, et al. Hemoperitoneum caused by spontaneous rupture of hepatocellular carcinoma in noncirrhotic liver. A case report and systematic review. Open Med (Wars), 2020, 15(1): 739-744.
65.	Wu JJ, Zhu P, Zhang ZG, et al. Spontaneous rupture of hepatocellular carcinoma: optimal timing of partial hepatectomy. Eur J Surg Oncol, 2019, 45(10): 1887-1894.
66.	Lee HS, Choi GH, Choi JS, et al. Staged partial hepatectomy versus transarterial chemoembolization for the treatment of spontaneous hepatocellular carcinoma rupture: a multicenter analysis in Korea. Ann Surg Treat Res, 2019, 96(6): 275-282.
67.	Wang W, Meng T, Chen Y, et al. Propensity score matching study of 325 patients with spontaneous rupture of hepatocellular carcinoma. Hepatobiliary Surg Nutr, 2022, 11(6): 808-821.
68.	Li J, Huang L, Liu CF, et al. Risk factors and surgical outcomes for spontaneous rupture of BCLC stages A and B hepatocellular carcinoma: a case-control study. World J Gastroenterol, 2014, 20(27): 9121-9127.
69.	Xu X, Zhang HL, Liu QP, et al. Radiomic analysis of contrast-enhanced CT predicts microvascular invasion and outcome in hepatocellular carcinoma. J Hepatol, 2019, 70(6): 1133-1144.
70.	Han XJ, Su HY, Shao HB, et al. Prognostic factors of spontaneously ruptured hepatocellular carcinoma. World J Gastroenterol, 2015, 21(24): 7488-7494.
71.	Akhan O, Akçalar S, Ünal E, et al. Radiofrequency ablation for colorectal cancer liver metastases: outcomes and prognostic factors associated with survival. Turk J Gastroenterol, 2023, 34(6): 645-651.
72.	Izzo F, Granata V, Grassi R, et al. Radiofrequency ablation and microwave ablation in liver tumors: an update. Oncologist, 2019, 24(10): e990-e1005.
73.	Zhou H, Wu J, Ling W, et al. Application of microwave ablation in the emergent control of intraoperative life-threatening tumor hemorrhage during hepatic surgeries. Int J Hyperthermia, 2018, 34(7): 1049-1052.
74.	Kwak BJ, Park J, Kwon YK, et al. Intraoperative radiofrequency ablation and distilled water peritoneal lavage for spontaneously ruptured hepatocellular carcinoma. Ann Surg Treat Res, 2019, 97(6): 291-295.
75.	Baimas-George M, Watson M, Murphy KJ, et al. Treatment of spontaneously ruptured hepatocellular carcinoma: use of laparoscopic microwave ablation and washout. HPB (Oxford), 2021, 23(3): 444-450.

1. 姚一菲, 孙可欣, 郑荣寿. 《2022全球癌症统计报告》解读: 中国与全球对比. 中国普外基础与临床杂志, 2024, 31(7): 769-780.
2. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
3. Zhou M, Wang H, Zeng X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet, 2019, 394(10204): 1145-1158.
4. Samant H, Amiri HS, Zibari GB. Addressing the worldwide hepatocellular carcinoma: epidemiology, prevention and management. J Gastrointest Oncol, 2021, 12(Suppl 2): S361-S373.
5. Zhang SY, Guo DZ, Zhang X, et al. Prognosis of spontaneously ruptured hepatocellular carcinoma: a propensity score matching study. J Cancer Res Clin Oncol, 2023, 149(11): 8889-8896.
6. Huang X, Jia C, Xu L, et al. Survival of patients subjected to hepatectomy after spontaneous rupture of hepatocellular carcinoma: a meta-analysis of high-quality propensity score matching studies. Front Oncol, 2022, 12: 877091.
7. Wang P, Moses AS, Li C, et al. Prognosis factors of predicting survival in spontaneously ruptured hepatocellular carcinoma. Hepatol Int, 2022, 16(6): 1330-1338.
8. Sahu SK, Chawla YK, Dhiman RK, et al. Rupture of hepatocellular carcinoma: a review of literature. J Clin Exp Hepatol, 2019, 9(2): 245-256.
9. Llovet JM, Kelley RK, Villanueva A, et al. Hepatocellular carcinoma. Nat Rev Dis Primers, 2021, 7(1): 6.
10. Yoshida H, Mamada Y, Taniai N, et al. Spontaneous ruptured hepatocellular carcinoma. Hepatol Res, 2016, 46(1): 13-21.
11. 蒲俊. 原发性肝癌自发性破裂出血相关危险因素分析. 宁夏医科大学, 2020.
12. 张仙. 原发性肝癌自发性破裂出血的相关危险因素及高危中医证型的分析. 成都中医药大学, 2021.
13. Chen Y, Guo D, Li X, et al. Predictors of spontaneous rupture of hepatocellular carcinoma and clinical outcomes following hepatectomy. Front Oncol, 2022, 12: 820867.
14. Ye F, Ma D, Gong XY, et al. Development and validation of risk score for predicting spontaneous rupture of hepatocellular carcinoma. Ann Surg Treat Res, 2020, 99(5): 268-274.
15. Ni Q, Jia H, Zhang Y, et al. Treatment and prognosis study of spontaneous rupture hemorrhage in hepatocellular carcinoma: recommendations for adding the A1 stage to the BCLC staging system. Cancer Med, 2024, 13(10): e6952.
16. Dolapsakis C, Pavli P, Panagopoulos A, et al. Haemoperitoneum due to spontaneous rupture of a liver metastasis. Eur J Case Rep Intern Med, 2019, 6(7): 001142.
17. Lally JSV, Ghoshal S, DePeralta DK, et al. Inhibition of Acetyl-CoA Carboxylase by phosphorylation or the inhibitor ND-654 suppresses lipogenesis and hepatocellular carcinoma. Cell Metab, 2019, 29(1): 174-182.
18. Kim NS, Chun HR, Jung HI, et al. Spontaneous rupture of pyogenic liver abscess with subcapsular hemorrhage mimicking ruptured hepatocellular carcinoma: a case report. Medicine (Baltimore), 2021, 100(15): e25457.
19. Cheng K, Cai N, Zhu J, et al. Tumor-associated macrophages in liver cancer: from mechanisms to therapy. Cancer Commun (Lond), 2022, 42(11): 1112-1140.
20. Yang Q, Li X. Molecular network basis of invasive pituitary adenoma: a review. Front Endocrinol (Lausanne), 2019, 10: 7.
21. 曾俊莉, 袁冬梅, 刘红兵, 等. 血管正常化与肿瘤免疫治疗. 中国肺癌杂志, 2014, 17(3): 273-276.
22. Rossaint J, Margraf A, Zarbock A. Perioperative inflammation. Anaesthesist, 2019, 68(7): 421-427.
23. Zeng L, Zhu L, Fu S, et al. Mitochondrial dysfunction-molecular mechanisms and potential treatment approaches of hepatocellular carcinoma. Mol Cell Biochem, 2025, 480(4): 2131-2142.
24. Fujita M, Yamaguchi R, Hasegawa T, et al. Classification of primary liver cancer with immunosuppression mechanisms and correlation with genomic alterations. EBioMedicine, 2020, 53: 102659.
25. Liang N, Yang T, Huang Q, et al. Mechanism of cancer stemness maintenance in human liver cancer. Cell Death Dis, 2022, 13(4): 394.
26. Xiao Y, Peng L, Xu H, et al. Mechanism of liver regeneration during ALPPS. Front Cell Dev Biol, 2022, 10: 916286.
27. Zhu LX, Meng XL, Fan ST. Elasticity of small artery in patient with spontaneous rupture of hepatocellular carcinoma. Hepatol Res, 2004, 29(1): 13-17.
28. Dezső K, Paku S, Kóbori L, et al. What makes cirrhosis irreversible?-Consideration on structural changes. Front Med (Lausanne), 2022, 9: 876293.
29. Kaneko S, Asahina Y, Murakawa M, et al. Analysis of prognosis and background liver disease in non-advanced hepatocellular carcinoma in two decades. PLoS One, 2024, 19(3): e0297882.
30. Battula N, Tsapralis D, Takhar A, et al. Aetio-pathogenesis and the management of spontaneous liver bleeding in the West: a 16-year single-centre experience. HPB (Oxford), 2012, 14(6): 382-389.
31. Álvarez-García M, Otegui Martínez-Peñuela L, Calvo Hernández R, et al. Uncommon etiology of Cullen sign and Grey Turner sign. Rev Esp Enferm Dig, 2024, 116(5): 280.
32. Kashiwadate T, Hara Y, Hashizume E, et al. A case of spontaneously ruptured hepatic angiosarcoma resected after transcatheter arterial embolization. J Surg Case Rep, 2022, 2022(9): rjac406.
33. Lee HY, Hong SK, Hong SY, et al. Outcomes of living donor liver transplantation in patients with a history of ruptured hepatocellular carcinoma. Front Surg, 2021, 8: 722098.
34. Zhu LX, Wang GS, Fan ST. Spontaneous rupture of hepatocellular carcinoma. Br J Surg, 1996, 83(5): 602-607.
35. Kim PT, Su JC, Buczkowski AK, et al. Computed tomography and angiographic interventional features of ruptured hepatocellular carcinoma: pictorial essay. Can Assoc Radiol J, 2006, 57(3): 159-168.
36. Darnis B, Rode A, Mohkam K, et al. Management of bleeding liver tumors. J Visc Surg, 2014, 151(5): 365-375.
37. Péčová M, Benko J, Péč MJ, et al. A rare early-onset fatal complication after transarterial chemoembolization: a case report and review of the literature. Curr Oncol, 2024, 31(4): 1961-1970.
38. Zhou J, Sun H, Wang Z, et al. Guidelines for the diagnosis and treatment of hepatocellular carcinoma (2019 edition). Liver Cancer, 2020, 9(6): 682-720.
39. Xia F, Ndhlovu E, Zhang M, et al. Ruptured hepatocellular carcinoma: current status of research. Front Oncol, 2022, 12: 848903.
40. Zhong F, Cheng XS, He K, et al. Treatment outcomes of spontaneous rupture of hepatocellular carcinoma with hemorrhagic shock: a multicenter study. Springerplus, 2016, 5(1): 1101.
41. Hsueh KC, Fan HL, Chen TW, et al. Management of spontaneously ruptured hepatocellular carcinoma and hemoperitoneum manifested as acute abdomen in the emergency room. World J Surg, 2012, 36(11): 2670-2676.
42. Liu CL, Fan ST, Lo CM, et al. Management of spontaneous rupture of hepatocellular carcinoma: single-center experience. J Clin Oncol, 2001, 19(17): 3725-3732.
43. Chen CS, Ahn H, Shin JH, et al. Renal artery embolization for spontaneous hemorrhage in patients with acquired cystic kidney disease: a 20-year single-center experience. Pak J Med Sci, 2021, 37(4): 1111-1117.
44. Okada N, Niimi K, Asami Y, et al. Retroperitoneal hematoma during prophylactic dose of heparin therapy for coronavirus disease 2019. Tokai J Exp Clin Med, 2023, 48(1): 47-51.
45. Yan J, Li T, Deng M, et al. Ruptured hepatocellular carcinoma: what do interventional radiologists need to know? Front Oncol, 2022, 12: 927123.
46. Zhu Q, Li J, Yan JJ, et al. Predictors and clinical outcomes for spontaneous rupture of hepatocellular carcinoma. World J Gastroenterol, 2012, 18(48): 7302-7307.
47. Zou J, Li C, Chen Y, et al. Retrospective analysis of transcatheter arterial chemoembolization treatment for spontaneously ruptured hepatocellular carcinoma. Oncol Lett, 2019, 18(6): 6423-6430.
48. Shinmura K, Choi YH, Shimohira M, et al. Comparison of conservative treatment versus transcatheter arterial embolisation for the treatment of spontaneously ruptured hepatocellular carcinoma. Pol J Radiol, 2018, 83: e311-e318.
49. Marcacuzco Quinto A, Nutu OA, San Román Manso R, et al. Complications of transarterial chemoembolization (TACE) in the treatment of liver tumors. Cir Esp (Engl Ed), 2018, 96(9): 560-567.
50. Kung CT, Liu BM, Ng SH, et al. Transcatheter arterial embolization in the emergency department for hemodynamic instability due to ruptured hepatocellular carcinoma: analysis of 167 cases. AJR Am J Roentgenol, 2008, 191(6): W231-W239.
51. Shin BS, Park MH, Jeon GS. Outcome and prognostic factors of spontaneous ruptured hepatocellular carcinoma treated with transarterial embolization. Acta Radiol, 2011, 52(3): 331-335.
52. Cheng YT, Teng W, Lui KW, et al. MELD score is the better predictor for 30-day mortality in patients with ruptured hepatocellular carcinoma treated by trans-arterial embolization. Am J Cancer Res, 2021, 11(7): 3726-3734.
53. Zhang W, Huang Z, Che X. Emergency versus delayed hepatectomy following transarterial embolization in spontaneously ruptured hepatocellular carcinoma survivors: a systematic review and meta-analysis. World J Surg Oncol, 2022, 20(1): 365.
54. 段昌虎, 刘晓晨, 段建峰, 等. 肝癌破裂出血急诊TAE序贯手术切除联合腹腔热灌注化疗等综合治疗的研究分析. 肝脏, 2022, 27(4): 455-459.
55. Xu X, Chen C, Liu Q, et al. A meta-analysis of TAE/TACE versus emergency surgery in the treatment of ruptured HCC. Cardiovasc Intervent Radiol, 2020, 43(9): 1263-1276.
56. 蔡重阳, 胡深, 赵金锋, 等. 肝切除手术时机对肝癌破裂出血治疗效果的影响. 中国医刊, 2020, 55(9): 954-957.
57. 赵亮. 原发性肝癌破裂出血一期切除与TACE后二期切除的疗效评估. 江汉大学, 2021.
58. Yang H, Chen K, Wei Y, et al. Treatment of spontaneous ruptured hepatocellular carcinoma: a single-center study. Pak J Med Sci, 2014, 30(3): 472-476.
59. Zhang FQ, Li L, Huang PC, et al. Transarterial embolization with hepatectomy for ruptured hepatocellular carcinoma: a meta-analysis. Minim Invasive Ther Allied Technol, 2022, 31(5): 676-683.
60. Lai EC, Lau WY. Spontaneous rupture of hepatocellular carcinoma: a systematic review. Arch Surg, 2006, 141(2): 191-198.
61. Kwon JH, Song GW, Hwang S, et al. Surgical outcomes of spontaneously ruptured hepatocellular carcinoma. J Gastrointest Surg, 2021, 25(4): 941-953.
62. Marini P, Vilgrain V, Belghiti J. Management of spontaneous rupture of liver tumours. Dig Surg, 2002, 19(2): 109-113.
63. Chen ZY, Qi QH, Dong ZL. Etiology and management of hemmorrhage in spontaneous liver rupture: a report of 70 cases. World J Gastroenterol, 2002, 8(6): 1063-1066.
64. Tartaglia N, Di Lascia A, Cianci P, et al. Hemoperitoneum caused by spontaneous rupture of hepatocellular carcinoma in noncirrhotic liver. A case report and systematic review. Open Med (Wars), 2020, 15(1): 739-744.
65. Wu JJ, Zhu P, Zhang ZG, et al. Spontaneous rupture of hepatocellular carcinoma: optimal timing of partial hepatectomy. Eur J Surg Oncol, 2019, 45(10): 1887-1894.
66. Lee HS, Choi GH, Choi JS, et al. Staged partial hepatectomy versus transarterial chemoembolization for the treatment of spontaneous hepatocellular carcinoma rupture: a multicenter analysis in Korea. Ann Surg Treat Res, 2019, 96(6): 275-282.
67. Wang W, Meng T, Chen Y, et al. Propensity score matching study of 325 patients with spontaneous rupture of hepatocellular carcinoma. Hepatobiliary Surg Nutr, 2022, 11(6): 808-821.
68. Li J, Huang L, Liu CF, et al. Risk factors and surgical outcomes for spontaneous rupture of BCLC stages A and B hepatocellular carcinoma: a case-control study. World J Gastroenterol, 2014, 20(27): 9121-9127.
69. Xu X, Zhang HL, Liu QP, et al. Radiomic analysis of contrast-enhanced CT predicts microvascular invasion and outcome in hepatocellular carcinoma. J Hepatol, 2019, 70(6): 1133-1144.
70. Han XJ, Su HY, Shao HB, et al. Prognostic factors of spontaneously ruptured hepatocellular carcinoma. World J Gastroenterol, 2015, 21(24): 7488-7494.
71. Akhan O, Akçalar S, Ünal E, et al. Radiofrequency ablation for colorectal cancer liver metastases: outcomes and prognostic factors associated with survival. Turk J Gastroenterol, 2023, 34(6): 645-651.
72. Izzo F, Granata V, Grassi R, et al. Radiofrequency ablation and microwave ablation in liver tumors: an update. Oncologist, 2019, 24(10): e990-e1005.
73. Zhou H, Wu J, Ling W, et al. Application of microwave ablation in the emergent control of intraoperative life-threatening tumor hemorrhage during hepatic surgeries. Int J Hyperthermia, 2018, 34(7): 1049-1052.
74. Kwak BJ, Park J, Kwon YK, et al. Intraoperative radiofrequency ablation and distilled water peritoneal lavage for spontaneously ruptured hepatocellular carcinoma. Ann Surg Treat Res, 2019, 97(6): 291-295.
75. Baimas-George M, Watson M, Murphy KJ, et al. Treatment of spontaneously ruptured hepatocellular carcinoma: use of laparoscopic microwave ablation and washout. HPB (Oxford), 2021, 23(3): 444-450.

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