Objective To investigate the therapeutic strategy for spontaneous rupture of hepatocellular carcinoma ( HCC) . Methods A retrospective analysis was performed on the clinical data of 30 patients with HCC rupture hospitalized at our hospital from January 2008 to December2011, including nine patients treated by primary surgical tumor resection and 21 patients treated with emergency transcatheter arterial chemoembolization ( TACE) . Of the latter group, 10 patients underwent surgical tumor resection after TACE and the other 11 patients were treated with TACE alone. Treatment outcomes were evaluated and compared. Categorical data were compared using the chi- square test or Fisher's test. Results The success rate of hemostasis was 100% in the 21 patients treated with TACE, of whom 10 patients received tumor resection within 2- 5 weeks after TACE and HCC was confirmed by postoperative pathology. No peritoneal metastasis was noted three months after surgery. One- year survival rate was 70% ( 7 /10) . Of the nine patients treated by primary surgical tumor resection, two died during the perioperative period and five developed peritoneal or port- site metastasis within three months, and one- year survival rate was 44. 4% ( 4 /9) . For the 11 cases treated with TACE alone, one- year survival rate was 27. 3% ( 3 /11) . Conclusion TACE combined with surgical tumor resection is the preferred emergency treatment for spontaneous rupture of primary HCC. It can significantly increase the success rate of rescuing patients with HCC rupture and tumor resection rate, significantly decrease peritoneal metastasis rate, and prolong the survival of the patients.