Bile Duct Injury After Transcatheter Arterial Chemoembolization For Hepatic Carcinoma

Purpose:To retrospectively evaluate the risk factors and the clinical outcomes of bile duct injury after transcatheter arterial chemoembolization (TACE) for hepatic carcinoma (HCC), and provide suggestions for clinical prevention and treatment of bile duct injury.Materials and Methods:All patients underwent TACE for HCC were reviewed, including patients’ demographics, imaging, laboratory datas and treatment, indented for bile duct injury. The risk factors and clinic outcome for bile duct injury were analyzed.Results:From January2012to December2014, a total of483patients received TACE at our single institution, and21patients were identified to have bile duct injury (20cases of intrahepatic bile ducts dilation,9cases of biloma, and6cases of hepatic bile duct stricture). There were17male and4female, with mean age of59.8±11.6(range,34-84). The average onset of bile duct injury following TACE is3.9±2.7months. Postoperative follow-up has indicated that alanine aminotransferase (ALT), aspertate aminotransferase (AST), alkaline phosphatase (ALP) and gamma glutamyl transpeptidase (GGT) increased significantly compared with pre-TACE. Particularly, in16of21patients had surgical tumor resection prior to TACE, the other5patients who have no hepatectomy history (P=0.039). After medicine conservative treatment and biliary tract outside drainage,10cases of liver function improved, however4patients with hepatic bile duct stricture and biloma, drainage effect is not obvious, afterwards develop biliary complications such as infection, gallbladder and intrahepatic bile duct stones. Liver cirrhosis decompensation complications in3cases, and finally1case died due to hepatic encephalopathy. Recurrence of HCC have4cases during the follow-up period.Conclusions:Bile duct injury complicated with TACE was not caused by single factor, but is induced by a variety of factors, and has a close relationship with the blood vessels injury that supply the bile duct and long-term biliary infection. The rapid rise of ALP, GGT and total bilirubin in a week after TACE can be predicted to bile duct injury and early intervention may prevent the occurrence of complications.The probability of bile duct injury caused by preventive TACE-procedure increased significantly, especially patients which have been performed hepatectomy for hepatic malignancy prior to TACE, so we suggest needing to comprehensively evaluate patient’s condition, whether really need to do preventive treatment, lest cause serious complications to patients.