RESUMO
Objective To explore the causes, diagnosis and treatment of biliary tract hemorrhage after hepatic cancer thermal ablation. Methods The clinical data of 6 patients with biliary tract hemorrhage developed after hepatic cancer thermal ablation in our hospital from May 2013 to May 2018 were retrospectively analyzed. Endoscopic or digital subtraction angiography (DSA) was used to determine the bleeding points. After a definite diagnosis of biliary tract hemorrhage, selective hepatic artery embolization was performed. Hemoglobin, hepatic function and other indicators were detected after surgery to evaluate the treatment effect. Results Preoperative imaging diagnosis showed that 3 patients had mild dilatation of the intrahepatic bile duct. Endoscopy examination showed that there was persistent bleeding in the duodenal papilla with blood clot formation in all 6 patients. DSA examination showed that there were clear bleeding points in 4 patients, and no bleeding points in 2 patients. After embolization, the patients complained of biliary colic disappearance. Within 24 h after embolization, the patients still had hematochezia but the hemoglobin levels were stable. After 24 h operation, the hematochezia gradually disappeared. After selective hepatic artery embolization treatment, 6 patients obtained good hemostatic effects with the effective rate being 100%. All patients were discharged. No biliary bleeding reoccured in the 6-month follow-up. Conclusion Local expansion of intrahepatic bile duct is one of the main risk factors of biliary tract hemorrhage after hepatic cancer ablation. Triad of biliary bleeding is a typical symptom. Endoscopic detection rate is high. DSA examination diagnosis still need to be supported by clinical symptoms. Selective hepatic artery embolization is an effective treatment method. Selective hepatic artery embolization is also satisfactory in diagnostic treatment of patients without bleeding points on DSA examination.