Primary hepatocellular carcinoma (PHC) is one of the malignant tumors that seriously threaten human health, ranking 5th among common solid tumors and 4th among related tumor causes of death. 260,000 new cases of hepatocellular carcinoma occur each year worldwide, with significantly more men than women, and the ratio of men to women is 3.2:1. 80% of new cases are found in developing countries, and about 110,000 people die of hepatocellular carcinoma each year in China, accounting for 45% of the deaths from hepatocellular carcinoma worldwide. The clinical manifestations and changes of the disease are complex, and its lethal acute complications include upper gastrointestinal bleeding, hepatocellular carcinoma rupture, biliary obstruction, spontaneous hypoglycemia, hepatorenal syndrome, vena cava obstruction, hepatic encephalopathy, etc. Among them, the common causes of death are upper gastrointestinal bleeding and ruptured bleeding of cancer nodes, followed by hepatic coma and hepatorenal syndrome. These acute complications often cannot be handled by surgery, oncology and ICU alone, and physicians often have the main responsibility in treatment, so it is very important to actively diagnose and treat acute complications of primary liver cancer at an early stage. Patients with primary hepatocellular carcinoma are mostly combined with cirrhosis, poor liver reserve function, high incidence of portal hypertension and esophagogastric fundic varices. Among them, 15?1% of patients die from upper gastrointestinal bleeding, low inactivation ability of corticosteroids and body hormones, peptic ulcers and gastric mucosal lesions are more common. Resuscitation measures 1, correct estimation of bleeding volume, active expansion, correction of shock. 2, drug treatment (1) vasopressin: posterior pituitary can rapidly constrict visceral blood vessels, reduce blood into the portal system, reduce portal pressure, to achieve hemostatic efficacy, the success rate of hemostasis is 50% ~ 70%, the better solution is to give posterior pituitary 10IU intravenous push for the first time, followed by 0?1 ~ 0?3IU/min intravenous drip rate, maintain 48 ~ 72h. The dose can be gradually increased according to the response to treatment, but should not exceed 0?4 U/min. If the bleeding is controlled, the drug should be continued for 8-12 h, and then discontinued. It can also be combined with the application of diastolic nitroglycerin and phentolamine to treat bleeding, which can significantly reduce portal pressure and increase the local effect to prevent cardiovascular complications. (2) Synthetic growth inhibitor: By reducing the blood flow in the main portal artery, reducing the portal pressure and providing conditions for coagulation, the success rate of hemostasis is 70% ~87%. Octreotide is a good and safe drug for the treatment of ruptured esophageal variceal bleeding complicated by primary liver cancer. It is proved that its hemostatic effect is dose-dependent, and octreotide is more effective when it is first given 0.1mg intravenously and then pumped continuously at 25ug/h until the bleeding stops. (3) Other hemostatic drugs: H2 receptor antagonists, proton pump inhibitors can inhibit the secretion of gastric acid and promote gastric mucosal repair, which has an important role in the prevention and treatment of vascular erosion. Norepinephrine cold solution taken orally intermittently can constrict the gastric fundus and small veins of the lower esophagus and play a hemostatic effect. 3.Double-balloon three-chamber tube compression: It is suitable for rescuing ruptured esophagogastric fundic variceal bleeding, and is still listed in the diagnosis and treatment guideline items of portal hypertension with bleeding, with precise effect of immediate hemostasis, and is advocated to be used before ligature and sclerotherapy injection. Modified single-capsule and five-lumen ones have been used in clinical practice. It is forbidden for those with cardia tear. 4, endoscopic hemostasis: endoscopic hemostasis has become the current preferred method of treatment of gastrointestinal bleeding. fleischerD endoscopic local hemostatic techniques are grouped into four categories: (1) Department of spray hemostatic drugs; (2) Department of injection of hemostatic drugs; (3) mechanical compression method; (4) thermogenic coagulation therapy. Other therapies such as endoscopic sclerotherapy and adhesive injection therapy, loop ligation therapy, and endoscopic loop ligation therapy have become the first choice for hemostasis with positive effect, and the Akita ligature and five-ring method and seven-ring method can be used. Rupture of primary liver cancer is one of the serious complications in the late stage of liver cancer, with the incidence rate accounting for about 14.5% of liver cancer and high death rate, accounting for the 4th or 5th cause of death of liver cancer patients. Rupture of hepatocellular carcinoma is mainly due to the spontaneous rupture of cancerous tissue due to necrosis and softening during the development of the disease and the erosion of blood vessels by the tumor. Among the pathological types, ruptured hepatocellular carcinoma with giant mass is more common, and CT is of great value in the diagnosis of spontaneous rupture of hepatocellular carcinoma. The rupture and bleeding of hepatocellular carcinoma has rapid onset, large bleeding volume and is accompanied by shock. In addition to active anti-shock, different plans are formulated according to specific conditions. Surgery is still the main treatment method, and hepatic resection remains an effective means to improve the prognosis of patients with ruptured PHC bleeding. Local sutures as well as large omental tamponade sutures are often used in patients who cannot be surgically resected or who are in poor general condition and in critical condition. In recent years, with the development of emergency intervention, transhepatic artery chemoembolization (TACE) for ruptured hepatocellular carcinoma bleeding has been widely performed in China. Multi-point injection of anhydrous alcohol next to the tumor can cause cellular protein coagulation leading to apoptosis of cancer cells. For patients with advanced hepatocellular carcinoma rupture or patients with Child-pugh grade C liver function, surgery is not considered, but symptomatic support and other treatments are provided. The prognosis is very poor, and death is often caused in a short period of time. For such patients, long-term use of drugs to reduce portal and hepatic artery pressure, such as octreotide, may be effective. Biliary obstruction About 19-40% of patients with advanced hepatocellular carcinoma have jaundice, while biliary obstruction in combination with hepatocellular carcinoma only accounts for 1?5%-10% of hepatocellular carcinoma. Jaundice in patients with hepatocellular carcinoma can be classified into 3 categories: 1) hepatocellular jaundice caused by extensive destruction of liver parenchyma by advanced hepatocellular carcinoma tumors; 2) jaundice caused by obstructive bile drainage due to large hepatocellular carcinoma masses or extrahepatic bile duct compression by portal lymph node metastases and hepatocellular carcinoma; 3) jaundice caused by obstruction of bile ducts due to bile duct emboli formed by hepatocellular carcinoma. ERCP technology is a good diagnostic and therapeutic tool for patients with hepatocellular carcinoma and obstructive jaundice, and the greatest advantage of ERCP is that it can be used for internal and external drainage, dilation and stenting of biliary obstruction, which is the most valuable development in recent years. primary hepatocellular carcinoma (HCC) combined with obstructive jaundice is an indication for ERCP application. The primary hepatocellular carcinoma with biliary tract cancer embolus is currently treated by aggressive surgery, and if combined with comprehensive treatment (TACE+T-tube chemotherapy drug drip or perfusion), it can significantly improve the efficacy and prognosis. For diffuse tumor lesions or large tumors that invade important anatomical structures and cannot be removed, severe hepatic sclerosis or poor liver function that cannot tolerate hepatic resection, hepatic artery ligation is feasible. For obstructive jaundice caused by tumor compression of bile ducts, if no surgical indication is available, the combined treatment by argon helium knife and percutaneous hepatic percutaneous biliary drainage (PTCD) can significantly improve the quality of life and prolong the survival time of patients. It has been advocated that TACE combined with PTCD can effectively relieve bile duct obstruction and improve liver function in advanced patients who are not suitable for surgery, and is a safer method for bile duct obstruction that cannot be treated surgically. In recent years, endoscopic biliary stent internal drainage has provided an effective treatment method for bile duct obstruction combined with hepatocellular carcinoma, and the commonly used routes are endoscopic transduodenal papilla placement and percutaneous transhepatic route placement. If the pressure in the bile duct is lowered by external drainage and the inflammatory edema is reduced, the guidewire can easily pass through the stenosis. Spontaneous hypoglycemia Patients with advanced hepatocellular carcinoma often show hypoglycemia or even hypoglycemic coma, which has a high death rate. The incidence rate reported in the literature can reach 10%~30%. The causes of hypoglycemia are complicated, but it is generally believed that: 1) the huge tumor tissue replaces most of the normal liver tissue and consumes a large amount of glucose every day; 2) the liver function of primary liver cancer patients, especially when combined with cirrhosis, is impaired, and glycogen synthesis, decomposition and gluconeogenesis are weakened, leading to hypoglycemia and even coma; 3) the inactivation of insulin in liver of liver cancer patients is weakened or ectopic insulin is secreted, leading to increased blood insulin level is elevated. This kind of spontaneous hypoglycemia occurs suddenly and may be extremely serious and difficult to correct, and even the blood sugar may still be zero while replenishing sugar. Clinically, if a patient with hepatocellular carcinoma develops dizziness, palpitations, cold sweats and impaired consciousness, the possibility of combined hypoglycemia should be considered in addition to the common causes of coma, and early detection and correction should be made. The characteristics are: 1) sudden and rapid coma lasting for several seconds to tens of seconds; 2) occurring mostly from 1:00 to 7:00, with few episodes during daytime; 3) relieved by glucose infusion; 4) with the progress of liver disease, the degree and frequency of episodes may increase. Therefore, the condition should be closely observed, blood glucose should be monitored, and according to the blood glucose and insulin level, the main measures should be taken to adjust the diet and calorie distribution to reduce and correct the attack of hypoglycemic reaction, which can achieve good results. In case of hypoglycemic coma, glucose supplementation should be immediately supplemented with glucagon including adrenocorticotropic hormone. V. Hepatorenal syndrome Hepatorenal syndrome, also known as functional renal failure, is characterized by renal vasoconstriction and a dramatic decrease in glomerular filtration rate. The current study proves that the contraction of renal vasculature is related to the increase of blood renin-angiotensin II, endotoxemia in liver failure, reduction of vasodilator and kininogen synthesis in the liver, etc. It is often accompanied by severe electrolyte disorders, hypokalemia and acidosis. Hepatorenal syndrome is a serious complication of advanced hepatocellular carcinoma, which has a high mortality rate and no effective treatment method at present. The treatment of hepatorenal syndrome is a serious complication of advanced hepatocellular carcinoma. Early prevention and elimination of factors inducing liver and kidney failure, such as infection, bleeding, electrolyte disorders, inappropriate discharge of ascites, diuresis, etc. can reduce mortality. Once renal failure occurs, Chinese and Western medicine must be combined to actively rescue the patient, while early hemodialysis, application of diuretic combination and use of artificial liver may be effective. Vena cava obstruction Hepatocellular carcinoma invades the inferior vena cava and forms cancer thrombus or cancer thrombus in it, thus manifesting as inferior vena cava obstruction, the incidence of which is 30%~47.5% as reported abroad and less than 2% as reported in China. The clinical manifestations of hepatocellular carcinoma in these patients are atypical, mainly symptoms of inferior vena cava obstruction and portal hypertension, and the symptoms appear rapidly, such as ascites, varices in the thoracoabdominal wall and swelling in the lower limbs within days to weeks. Ultrasound can show the sonographic characteristics of intrahepatic tumors and intravenous cancer clots as well as hemodynamic changes, which are of great value for follow-up examinations, surgery, and interventional treatment. Imaging can reveal signs of inferior vena cava obstruction such as striated occupancy in the inferior vena cava and/or hepatic veins. With the prolongation of survival and the popularity of interventional treatment, this complication tends to increase. Treatment: Surgical management of inferior vena cava obstruction caused by hepatocellular carcinoma invading the inferior vena cava is not possible. Thrombolysis and balloon dilation alone are not as effective as implantation of internal stents. Metal endoprosthesis has continuous tension, which can maintain the patency of the vascular lumen and prevent the elastic retraction of the lesion, and at the same time, it has obvious squeezing pressure on the tumor tissue to hinder its growth. However, interventional treatment has complications such as pulmonary embolism caused by thrombus or tumor embolus dislodgement, inaccurate stent implantation or dislocation into the heart, vessel perforation and rupture, cardiac failure, etc. Therefore, it is advocated that thrombolysis before inferior vena cava dilation can effectively prevent pulmonary embolism. VII Hepatic encephalopathy Hepatic encephalopathy is a common complication of end-stage hepatocellular carcinoma, and about 30% of patients die as a result. The occurrence of hepatic encephalopathy is closely related to the failure of liver function. It can be induced by upper gastrointestinal bleeding, hepatocellular carcinoma rupture and bleeding, secondary infection, excessive discharge of ascites, use of high-dose diuretics, surgical trauma, application of liver-damaging drugs and high protein diet. Treatment: Once hepatocellular carcinoma is complicated with hepatic encephalopathy, the prognosis is poor, so early detection, early diagnosis and early treatment should be emphasized. 1.Treatment for tumor: Usually, patients with hepatic encephalopathy seldom adopt “aggressive treatment” for tumor, such as surgery, radiotherapy, chemotherapy, etc.; 2.Remove causative factors: actively prevent and treat infection and gastrointestinal bleeding, avoid the use of diuretics and discharge of ascites, prohibit anesthetics and sedatives (such as morphine, etc.). 3. Nutrition and diet: limit the intake of protein and ensure sufficient calories and vitamins, and nasal feeding or intravenous supplementation for patients who cannot eat; 4. Some literature suggests that early brain nutrition drugs and drugs to prevent or reduce free radical formation can reduce the occurrence of hepatic encephalopathy, such as the use of small doses of mannitol, etc.; 5. Chinese medicine treatment. Acute complications of primary hepatocellular carcinoma are late events of hepatocellular carcinoma, and many patients end up as a result. Therefore, the most effective way to prevent and treat complications of liver cancer and cirrhosis should be to catch early detection, early diagnosis and standardized treatment. Nowadays, the treatment of solid tumors of the digestive tract also emphasizes early and consistent biological conditioning treatment, which can regulate the individual’s ability to resist cancer and improve the performance of various therapeutic effects in order to minimize the occurrence of acute complications.