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Title: Portomesenteric Venous Stenting for Palliation of Ascites and Variceal Bleeding Caused by Prehepatic Portal Hypertension.
Author: Sheth RA, Sabir SH, Parmet P, Amin R, Kuban JD, Huang SY, Mahvash A, Fogelman D, Javle M, Wallace MJ.
Journal: Oncologist; 2018 Jun; 23(6):712-718. PubMed ID: 29284759.
Abstract:
BACKGROUND: The purpose of this study was to evaluate percutaneous transhepatic portal vein stenting (PVS) for palliation of refractory ascites and/or variceal bleeding caused by extrahepatic portomesenteric venous stenosis in patients with pancreaticobiliary cancer. MATERIALS AND METHODS: A single-institution, retrospective review of patients who underwent PVS between January 2007 and July 2015 was performed. A total of 38 patients were identified, of whom 28 met the inclusion criterion of PVS performed primarily for refractory ascites or variceal bleeding. In addition to technical success and overall survival, clinical success was measured by fraction of remaining life palliated. The palliative effect of PVS was also quantified by measuring changes in liver and ascites volumes after the procedure. RESULTS: Technical success was 93% (26/28). Stent deployment involved more than one portomesenteric vessel in most patients (20/26). The cumulative probability of symptom recurrence at 6, 12, 18, and 24 months was 12%, 16%, 26%, and 40%, respectively. There was a significant difference (p < .001) in the probability of symptom recurrence, recurrence of abdominal ascites, and increase in liver volume between patients whose stents remained patent and those whose stents demonstrated partial or complete occlusion. The mean fraction of remaining life palliated was 87%. All but two patients were found to have improvement in clinical symptoms for the majority of their lives after the procedure. There were no major or minor complications. CONCLUSION: As a low-risk procedure with a high clinical success rate, PVS can play a substantial role in improving quality of life in patients with portomesenteric stenoses. IMPLICATIONS FOR PRACTICE: Portomesenteric venous stenosis is a challenging complication of pancreaticobiliary malignancy. Portomesenteric stenoses can lead to esophageal, gastric, and mesenteric variceal bleeding, as well as abdominal ascites. The purpose of this study was to evaluate the safety and efficacy of portal vein stenting (PVS) in patients with cancer who have symptomatic portal hypertension caused by portomesenteric venous compression. As a low-risk procedure with a high clinical success rate, PVS can play a substantial role in improving quality of life in patients with portomesenteric stenoses. 摘要 背景。本研究旨在评估用于缓解由胰腺胆管癌患者肝外门肠系膜静脉狭窄导致的顽固性腹水和/或静脉曲张出血的经皮肝穿刺门静脉支架置入术（PVS）。 材料与方法. 针对 2007 年 1 月至 2015 年 7 月间做过 PVS 手术的患者, 执行的一次单一机构回顾性患者调查。共 38 位患者参与研究, 其中 28 位符合“主要因顽固性腹水或静脉曲张出血而实施 PVS 手术”的遴选标准。除技术成功率和总体存活率外, 还通过患者余生痛苦缓解所占时间比来衡量其临床成功率。亦通过术后对于肝脏与腹水量变化的测量, 量化 PVS 的缓解效应。 结果。技术成功率为 93% （26/28）。大多数患者的门肠系膜静脉置入了多个支架（20/26）。6、12、18 和 24 个月的累积症状复发机率分别为 12%、16%、26% 和 40%。支架保持敞开状态的患者与支架出现部分或完全闭合的患者之间在症状复发、腹水复发以及肝体积变大机率方面, 存在显著差异 (p<0.001)。余生痛苦缓解平均占比为 87%。除两人外, 其余患者术后余生的大多数时间均见临床症状改善。未见严重或轻微并发症。 结论。PVS 手术风险小、临床成功率高, 可在改善门肠系膜狭窄患者生活质量中发挥重大作用。 于临床实践的提示意义：门肠系膜静脉狭窄是一种难治的胰胆系恶性肿瘤并发症。门肠系膜静脉狭窄可导致食道、胃、肠系膜静脉曲张性出血以及腹水。本研究旨在评估门静脉支架 (PVS) 对于有因门肠系膜静脉压迫导致的门静脉高压症状的癌症患者的安全性和有效性。PVS 手术风险小、临床成功率高, 可在改善门肠系膜狭窄患者生活质量中发挥重大作用。

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