探讨肝细胞癌（肝癌）经导管动脉化疗栓塞（TACE）术后严重并发症的诊治经验。

回顾性分析2011年6月至2013年5月在中山大学附属第三医院岭南医院普通外科收治的15例肝癌TACE术后严重并发症患者临床资料。所有患者均签署知情同意书，符合医学伦理学规定。其中男12例，女3例；年龄40～78岁，中位年龄55岁。

患者均有腹痛、发热、白细胞升高等胆管炎表现。根据患者临床表现、TACE治疗史和影像学检查，确诊为肝癌TACE术后胆汁瘤10例、肝脓肿4例、缺血性胆管炎1例。所有患者均给予抗感染、利胆及护肝等基础治疗。10例胆汁瘤患者行超声引导下经皮穿刺胆汁瘤置管引流、经皮经肝胆道引流术（PTCD）、内镜下鼻胆管引流后治愈。4例肝脓肿患者在超声引导下经皮穿刺肝脓肿置管引流、局部抗生素冲洗后治愈。1例缺血性胆管炎患者经放置3条PTCD管引流，血清胆红素由500 μmol/L降至300 μmol/L，但最终因并发严重胆道感染及消化道出血放弃治疗。

肝癌TACE术后严重并发症的诊断主要依据临床表现、TACE治疗史和影像学检查。治疗方法包括抗感染、利胆、护肝等基础治疗，以及超声引导下穿刺引流、PTCD、内镜下鼻胆管引流等引流对症治疗。

To review the diagnosis and treatment of severe complications after transcatheter arterial chemoembolization (TACE) of hepatocellular carcinoma (HCC).

Clinical data of 15 patients with severe complications after TACE of HCC in Department of General Surgery, Lingnan Hospital, the Third Affiliated Hospital of Sun Yat-sen University from June 2011 to May 2013 were analyzed retrospectively. The informed consents of all patients were obtained and the ethics committee approval was received. There were 12 males and 3 females with age ranging from 40 to 78 years old and the median age of 55 years old.

Manifestations of cholangitis such as abdominal pain, fever, rising white blood cell etc. were observed in all the patients. According to the clinical manifestations, history of receiving TACE and imaging examinations, 10 cases were diagnosed with biloma after TACE of HCC, 4 cases with liver abscess and 1 case with ischemic cholangitis. All the patients received basic treatments of anti-infection, cholagogue and liver protection. Ten cases with biloma were cured after receiving ultrasound-guided percutaneous transcatheter drainage of biloma, percutaneous transhepatic cholangial drainage (PTCD) and endoscopic nasobiliary drainage (ENBD). Four cases with liver abscess were cured after receiving ultrasound-guided percutaneous transcatheter drainage of liver abscess, local douche with antibiotics. One case with ischemic cholangitis received drainage of 3 catheters of PTCD and the serum bilirubin went down from 500 μmol/L to 300 μmol/L, but gave up treatment finally because of complicating severe biliary infection and gastrointestinal hemorrhage.

The diagnosis of severe complications after TACE of HCC is mainly based on the clinical manifestations, history of receiving TACE and imaging examinations. The therapies include basic treatments of anti-infection, cholagogue and liver protection etc., and symptomatic treatments of ultrasound-guided percutaneous drainage, PTCD, ENBD, etc.