【Abstract】Objective To explore the risk factors of biloma in elderly patients with primary hepatocellular carcinoma after interventional surgery. Methods A total of 632 elderly patients who underwent transcatheter arterial chemoembolization (TACE) for primary hepatocellular carcinoma (HCC) in Changzhi People′s Hospital affiliated to Changzhi Medical College from January 2021 to March 2023 were selected as the study subjects. They were followed up for 6 months, and 14 cases were lost to follow-up. According to whether they developed biloma after TACE, the patients were divided into biloma group (n=46) and non-biloma group (n=572). The general data such as gender, age, Child-Pugh grading, gamma-glutamyl transferase (GGT) and alkaline phosphatase (ALP) were compared between groups. SPSS 24.0 was used for data analysis. According to the data type, t test, Chi-square test or Fisher exact probability method was used for data comparison. Logistic regression analysis was used to evaluate the risk factors of biloma after TACE in elderly patients with primary HCC. Results The incidence of biloma after TACE was 7.44% (46/618) in 618 elderly patients with primary HCC. The incidence rate of preoperative biliary tract dilatation, the proportion of intraoperative use of polyvinyl alcohol particle, and the abnormal increase rates of GGT and ALP at one week after surgery in the biloma group were higher than those in the non-biloma group (P<0.05). Among the 46 patients with biloma, 36 (78.26%) were asymptomatic, among whom one had enlarged bilioma during follow-up and shrank after percutaneous biloma drainage. The other asymptomatic patients had no change or did not shrink. Ten (21.74%) patients had fever and jaundice. After percutaneous biloma drainage, biloma shrank in eight patients, disappeared in one, and shrank in one after percutaneous transhepatic biliary drainage due to poor drainage effect. Logistic regression analysis showed that preoperative biliary tract dilatation (OR=2.542,95%CI 1.503-4.300; P<0.05), intraoperative use of polyvinyl alcohol particle (OR=3.391,95%CI 2.145-5.360; P<0.05), abnormal increase of GGT at one week after surgery (OR=2.056,95%CI 1.049-4.031; P<0.05), and abnormal increase of ALP at one week after surgery (OR=2.450,95%CI 1.380-4.350; P<0.05) were risk factors of biloma in elderly patients with primary HCC after TACE. Conclusion Preoperative biliary tract dilatation, embolization with polyvinyl alcohol particle, and abnormal increases of GGT and ALP at one week after surgery are risk factors of biloma in elderly patients with primary HCC after TACE. Accordingly, it is necessary to formulate clinical prevention and control measures in order to improve the prognosis of patients.
