Abstract:Objective To investigate the clinical characteristics, risk factors, laboratory examination, diagnosis, treatment and prognosis of hepatocellular carcinoma complicated with acute pulmonary embolism (PE). Methods All 12 patients with hepatocellular carcinoma combined with acute pulmonary embolism from January 2012 to January 2016 received inferior vena cava filter implantation and intra-catheter pulmonary thrombolysis. During the operation, the patients were treated with 36 mg recombinant tissue plasminogen activator (rt-PA) (intra-arterial infusion, 18 mg every 30 minutes). After operation, low molecular weight heparin sodium injection (5 000 U, subcutaneous injection, q12 h) was given for 7 days and then converted to aspirin (100 mg, qd, Po) for 9 to 12 months. Results The chest CT angiography (CTA) showed that treatment significantly improved the degree of embolism. The recanalization rate was 33.3% (4/12) in bilateral trunk and its main branches, 66.7% (8/12) in unilateral trunk and its main branches and 100% (12/12) in sub-secondary branches. In terms of clinical symptoms, 12 cases of shock or hypotension recovered completely after treatment, 5 cases of right ventricular dysfunction were completely cured in 3 cases and 2 cases of partial clinical remission. There were 3 cases of pulmonary embolism triad, in which 2 cases were completely cured and 1 case was clinically remitted. In laboratory tests, pulmonary artery pressure [(45.73±2.42) mm Hg vs (25.21±1.69) mm Hg] and D-dimer [(5.72±4.19) mg/L vs (0.86±0.17) mg/L] were decreased and arterial partial pressure of oxygen (PaO₂) [(78.48±3.74) mm Hg vs (91.23±2.53) mmHg] was higher after the treatment (all P<0.01). Conclusion Hepatocellular carcinoma complicated with acute pulmonary embolism, accompanied by thrombosis of the main or main branches of pulmonary artery, requires inferior vena cava filter implantation and intra-ductal pulmonary thrombolysis. Percutaneous intra-ductal thrombolysis is most commonly used in patients with high or medium dangerous pulmonary embolism with high risk of bleeding. It should be treated in experienced hospitals, and by direct introductal thrombolysis. Direct intraductal thrombolysis is superior to systemic thrombolysis, and its dosage of the thrombolytic drug can reduced during intaductal thrombolysis, thereby reducing the risk of bleeding. Anticoagulant therapy is necessary after operation, and its clinical curative effect is affirmative.