胆管损伤是经导管动脉化疗栓塞（TACE）后的严重并发症。如果不及早发现并积极治疗，不仅会影响肝细胞癌（HCC）患者后续的肿瘤相关治疗，还可能导致感染、肝功能衰竭甚至死亡等严重后果。分析HCC患者TACE术后胆管损伤的危险因素，探讨TACE术后胆管损伤的预测指标，有助于医生及早发现和干预，避免严重并发症的发生。我院介入科首次接受TACE的847例原发性肝细胞癌患者的数据。根据TACE术后是否发生胆管损伤将患者分为两组：（1）胆管损伤组，N = 55例； (2)无胆管损伤组，N = 792，分析胆管损伤的基本资料、术中情况及转归。计数资料的比较采用卡方检验。测量数据的比较采用Mann-Whitney U检验。采用二元logistic回归分析进行危险因素分析。比较胆管损伤组与无胆管损伤组的基本资料和术中情况：术前碱性磷酸酶（ALP）（103.24±32.77U/L vs 89.17±37.35） U/L，P = 0.003）；肝胆手术史（36.4% vs. 20.8%，P = 0.011）；术中碘油用量(P = 0.007);联合使用明胶海绵颗粒（65.5% vs. 35.0%，P < 0.001）；血管不足（58.2% vs. 24.5%，P < 0.001）；和栓塞部位（P < 0.001）。胆管损伤组与非胆管损伤组术后肝功能比较：术后总胆红素（43.34±25.18umol/L比21.94±9.82umol/L，P<0.001）；术后γ-谷氨酰转移酶（GGT）（188.09 ± 55.62U/L vs. 84.04 ± 36.47U/L，P < 0.001）；术后ALP（251.51 ± 61.51U/L vs. 99.92 ± 45.98U/L，P < 0.001）。TACE中碘油用量、补充明胶海绵颗粒、栓塞部位、肿瘤血供不足是胆管癌的危险因素TACE 后受伤。 TACE后GGT、ALP较术前指标升高≥2倍，作为胆管损伤的预测指标。 TACE 后发生的胆管损伤可以通过积极的治疗取得良好的结果。© 2024。作者。

Bile duct injury is a serious complication after transcatheter arterial chemoembolization (TACE). If it is not detected early and treated actively, it will not only affect the subsequent tumor-related treatment of hepatocellular carcinoma (HCC) patients, but also may lead to serious consequences such as infection, liver failure and even death. To analyze the risk factors of bile duct injury after TACE in patients with HCC and explore the predictive indicators of bile duct injury after TACE, which is helpful for doctors to detect and intervene early and avoid the occurrence of serious complications.We retrospectively analyzed the clinical data of 847 patients with primary hepatocellular carcinoma who underwent TACE for the first time in our interventional department. Patients were divided into two groups according to whether bile duct injury occurred after TACE: (1) bile duct injury group, N = 55; (2) no bile duct injury group, N = 792. The basic data, intraoperative conditions and the outcome of bile duct injury were analyzed. The chi-square test was used for comparison of enumeration data. The Mann-Whitney U test was used for comparison of measurement data. Risk factor analysis was performed using binary logistic regression analysis.Basic data and intraoperative conditions were compared between the bile duct injury group and the group without bile duct injury: preoperative alkaline phosphatase (ALP) (103.24 ± 32.77U/L vs. 89.17 ± 37.35U/L, P = 0.003); history of hepatobiliary surgery (36.4% vs. 20.8%, P = 0.011); intraoperative lipiodol volume (P = 0.007); combined use of gelatin sponge particles (65.5% vs. 35.0%, P < 0.001); hypovascularity (58.2% vs. 24.5%, P < 0.001); and embolization site (P < 0.001). Comparison of postoperative liver function between bile duct injury group and non-bile duct injury group: postoperative total bilirubin (43.34 ± 25.18umol/L vs. 21.94 ± 9.82umol/L, P < 0.001); postoperative γ-glutamyltransferase(GGT) (188.09 ± 55.62U/L vs. 84.04 ± 36.47U/L, P < 0.001); postoperative ALP(251.51 ± 61.51U/L vs. 99.92 ± 45.98U/L, P < 0.001).The dosage of lipiodol in TACE, supplementation of gelatin sponge particles, embolization site, and hypovascularity of the tumor are risk factors for biliary duct injury after TACE. After TACE, GGT and ALP increased ≥ 2 times compared with preoperative indicators as predictors of bile duct injury. Bile duct injury occurring after TACE can achieve good outcomes with aggressive management.© 2024. The Author(s).