Transhepatic arterial chemoembolization (TACE) is currently recognized as the treatment of choice for unresectable hepatocellular carcinoma, which can effectively prolong the life of patients or reduce their pain. Although this method is a minimally invasive treatment, it still produces various complications. If the complications are not handled properly, it not only seriously affects the effect of interventional therapy for liver cancer, but also may generate unnecessary medical disputes. This article reviews the possible complications after various interventional therapies for hepatocellular carcinoma, as well as their treatment and preventive measures, in order to improve the attention and awareness of interventionalists. Common complications related to interventional therapy 1. Post-embolization syndrome: (1) Causes and manifestations: chemotherapeutic drugs lead to nausea and vomiting, embolization leads to tumor necrosis and organ congestion and edema, resulting in abdominal pain and fever, and some patients have vagal reflexes due to stimulation of vagus nerves by catheter sheaths, which is manifested as profuse sweating, slow pulse, and cold and wet limbs. (2) Treatment: Symptomatic treatment, application of antiemetics, analgesics, etc. 1-2 weeks can be recovered. Give atropine intramuscularly in case of vagal reflex. (2) Hepatic artery injury and liver parenchyma damage: (1) Causes: chemotherapeutic drugs or catheter damage to the endothelium; chemotherapeutic drugs damage to hepatocytes (2) Clinical manifestations: hepatic artery thinning, narrowing, or even occlusion; chronic liver damage, cirrhosis (3) Prevention: according to the diameter of the blood vessel to determine the depth of intubation, the application of micro-catheters; to reduce the damage to the thinner hepatic arteries, and to minimize the damage to the normal hepatic tissues, as far as possible, the super-selective intubation. (4) Treatment: 1-2 weeks of active hepatoprotective treatment after intervention can be recovered. 3, cholecystitis, gallbladder perforation: (1) Cause: embolic agent into the gallbladder artery. (2) Manifestation: pain in the gallbladder area after intervention. (3) Prevention: the catheter head should cross the gallbladder artery as far as possible, and do not inject chemoembolizing agent when the gallbladder artery is visualized by DSA. (4) Treatment: cholecystitis: antispasmodic, anti-inflammatory, choleretic. Gallbladder perforation: surgical treatment. 4, Wu thrombophlebitis: (1) cause: tumor with arteriovenous fistula, iodized oil through the fistula into the lung. (2) Manifestation: chest tightness, bloody sputum, cough, chest X-ray can see scattered iodized oil shadow. (3) Prevention: When arteriovenous fistula is found, the fistula is first blocked with a steel ring or gelatin sponge strip. (4) Treatment: anti-inflammatory, asthma, hormone treatment, 1-2 months can be self-absorbed. 5, cholangiocarcinoma: (1) cause: the reason is not clear, may be related to chemotherapy embolization damage to the bile duct. (2) Manifestation: irregular cystic changes appear beside the lesion, and thin bile can be extracted by puncture. (3) Treatment: after extracting bile, if the cholangioma is not connected with the bile duct, the cystic cavity can be cleared with anhydrous ethanol, and the larger ones can be placed in a tube for external drainage. 6. Spinal cord injury: (1) Cause: Embolization of tumor via intercostal artery when the spinal cord artery is mistakenly embolized. (2) Manifestation: lower limb sensory impairment, paraplegia in severe cases. (3) Prevention: Observe whether the spinal artery is visible when the blood supply from the lateral hepatic artery is found, and should not be embolized blindly. (4) Treatment: Once this complication occurs, timely vasodilatation, dehydration, improvement of microcirculation and neurotrophic treatment. 7.Intractable hiccups: (1) Causes and manifestations: the tumor is close to the diaphragm, or the tumor close to the diaphragm has phrenic artery supplying blood, and the tumor edema stimulates the diaphragm after interventional therapy, which causes intractable hiccups in patients. (2) Treatment: general therapy: breath holding after inhalation, pressing both eyeballs, pressing supraorbital nerve, carotid sinus compression, and so on. Drug therapy: Ritalin 10-20mg intramuscular injection, nifedipine 10-20mg sublingual or swallowed, tid. Transacupuncture therapy: acupoint pressure or acupoint injection. Commonly used acupoints and effective points include: stop-eruption point (equivalent to the supraorbital rim of the line connecting the zanzhu and eyeming points), neiguan, and footsanli. Some traditional Chinese medicines can be used for treatment. 8. Local hematoma: because of the prolonged blood clotting time of liver cancer patients and short time of local compression after treatment, etc. resulting in subcutaneous bleeding at puncture site. Treatment: 24 hours after intervention, local warm saline hot compress can be applied for 5-7 days. Complications in the natural course of liver cancer combined with liver cancer after liver cancer intervention 1. Digestive tract bleeding: there may be the following two reasons for digestive tract bleeding after liver cancer intervention: (1) Acute gastric mucous membrane damage: digestive tract bleeding due to the return of embolus into gastro-duodenal artery or direct damage to mucous membrane by chemotherapeutic drugs. (2) Portal hypertension: chemotherapy embolization can lead to further aggravation of cirrhosis, increased portal pressure, inducing esophagogastric fundus varices rupture bleeding. Prevention: (1) super-selective intubation to the tumor blood-supplying artery; (2) control the speed of bolus injection to prevent reflux; (3) postoperative application of gastric mucosal protection drugs such as cimetidine, omeprazole, etc.; (4) DSA imaging found that the arterio-portal shunt when the application of a steel ring to block the fistula to reduce portal pressure. Treatment: (1) bed rest, keep the respiratory tract open, prevent asphyxiation caused by blood inhalation when vomiting blood, oxygen inhalation if necessary, dietary restrictions. (2) Closely observe the heart rhythm, blood pressure, respiration, urinary changes and peripheral tissue perfusion, and correctly estimate the amount of bleeding. (3) Check blood routine urgently. Perform cardiac monitoring according to the situation. Immediately dispense blood and establish an effective intravenous fluid channel as soon as possible. Apply hemostatic drugs – growth inhibitors; preferred 14 peptide growth inhibitors; the first dose of 250ug intravenous slow infusion, followed by 250ug/h continuous intravenous drip. If interrupted for more than 5 minutes, the first dose needs to be reinjected. Growth inhibitor analog, octreotide (Zenith), may be used. The first dose of 100ug is given intravenously slowly, followed by 25-50ug/h continuous intravenous drip. Use acid-suppressing drugs: omeprazole 40mgiv, bid; cimetidine 400mgivdrip, q8h. Indications for emergency blood transfusion: syncope, drop in blood pressure, and increase in heart rate with change in position; systolic blood pressure less than 90mmHg or a 25% drop in blood pressure from basal blood pressure; hemoglobin less than 7g/L or hematocrit less than 25%. Endoscopic treatment: drug treatment is carried out after basic control of hemorrhage. 2.Hepatic rupture: Mostly occurs about one week after TACE, or may be spontaneous rupture. The manifestation is sudden abdominal pain or pain in the liver area, with acute abdominal manifestation, but if there is ascites, the acute abdominal manifestation is atypical. When rupture into the abdominal cavity with large amount of bleeding, peripheral circulatory failure may occur, causing shock. Diagnosis: ultrasound or CT found subperitoneal fluid dark area of the liver, or abdominal puncture extracted non-coagulated blood. Therapeutic measures. (1) replenish blood volume, correct shock; (2) bed rest, hepatic area pressure bandage; (3) hemostatic drugs: hemostatic triad (vitamin K140mg, hemostatic min 2.0, hemostatic aphthous acid 0.4) ivdripqd. injectable hemagglutinin: 1kU, iv or imbid. (4) hepatic artery embolization: apply gelatin sponge or stainless steel ring to perform hepatic left, hepatic right, or hepatic innate arterial embolization. (4) Embolization of hepatic artery: apply gelatin sponge or stainless steel ring to embolize the left, right or inherent hepatic artery. (3) Hepatic encephalopathy: Causes: mostly induced by large amount of protein intake, gastrointestinal bleeding, infection, inappropriate application of sedatives, strong diuresis, vomiting, diarrhea, hypokalemia and other factors. Manifestation: early thinking character abnormality, and then sleep or coma, may have fluttering vibration. Prevention: prevent constipation, control infection, reduce triggering factors. (1) Limit protein intake: 3~6g of essential amino acids per day. (2) Reduce ammonia absorption: lactulose 30~100ml/day, divided into 3~4 times. (3) Reduce blood ammonia: 4 sticks of monosodium glutamate/potassium glutamate; 10~20g/day of arginine; 20g/day of ornithine menthol (Yabus) for intravenous drip. (4) Correct acid-base imbalance and electrolyte disorders. 4.Hepatorenal syndrome: Causes: Liver insufficiency with large amount of ascites, such as large amount of ascites discharge, strong diuresis, vomiting, diarrhea, infection can be induced. Performance: oliguria, hypotension, azotemia. Prevention and treatment: eliminate the causative factors, active hepatoprotective therapy, avoid the use of drugs that damage renal function, transfusion of dextrose anhydride, plasma, albumin. Improve effective circulating blood volume, appropriately apply vasoactive drugs such as dopamine to improve renal blood flow 5. Infection: Causes: patients with hepatocellular carcinoma have low resistance themselves, and the aseptic operation of interventional therapy is not strict enough. Manifestation: fever, recent sudden increase of ascites in patients with ascites, abdominal pain. Prevention: nutritional support, improve resistance. Treatment: early, adequate amount, joint application of antibiotics, medication time is not less than two weeks. 6.Low sodium and hypochlorhydria: Causes: (1) It is caused by tumor tissue synthesis and autonomous release of ectopic ADH. (2) Nausea and vomiting after interventional chemotherapy. (3) Low-salt diet in chronic liver disease. Manifestation: Sudden loss of consciousness, twitching of limbs, coma, etc. Treatment: (1) The symptoms need to be relieved by timely supplementation of high-concentration sodium chloride solution. (2) Urgently check blood biochemistry, (hyponatremia is divided into severe low sodium <120mmol/L, moderate low sodium <130mmol/L, mild low sodium <135mmol/L). (3) Presence of obvious hyponatremia and hypochloremia, give supplemental 3% sodium chloride solution 1000ml, still in shallow coma continue to supplement sodium chloride.