Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
HPB (Oxford). 2021 Feb;23(2):238-244. doi: 10.1016/j.hpb.2020.06.003. Epub 2020 Jun 27.
The therapeutic effect of portal vein (PV) stenting for PV stenosis following nontransplant hepato-pancreato-biliary (HPB) surgery has not been fully investigated.
Changes in portal venous pressure (PVP) gradient before and after stenting, complications, symptomatic improvement, and stent patency were evaluated.
We identified 14 consecutive patients undergoing PV stenting for malignant (n = 8) and benign (n = 6) PV stenosis. Signs of PV stenosis were composed of refractory ascites in 6 patients, varices with hemorrhagic tendencies in 5, and abnormal liver function in 5. The median PVP gradient after PV stenting was 3.0 cm HO (range, 1.5-3.0), which was significantly smaller than that before PV stenting (median, 15 cm HO [range, 2.5-25]; P < 0.01). Thirteen out of 14 (93%) achieved clinical success with symptomatic improvement, except one patient with sustained refractory ascites because of peritoneal seeding. During the median follow-up time of 7.3 months (range, 1.0-87), stent occlusion occurred in two patients (14%) because of intrastent tumor growth. The 1-year cumulative stent patency rate was 76% in the entire cohort.
Based on durable effect on patency, we deemed PV stenting for PV stenosis after HPB surgery to be safe and beneficial for improving symptoms.
非肝移植肝胆胰（HPB）手术后门静脉（PV）狭窄的 PV 支架治疗效果尚未得到充分研究。
评估支架置入前后门静脉压力（PVP）梯度的变化、并发症、症状改善和支架通畅情况。
我们纳入了 14 例连续接受 PV 支架置入治疗恶性（n=8）和良性（n=6）PV 狭窄的患者。PV 狭窄的表现包括 6 例难治性腹水、5 例伴出血倾向的静脉曲张和 5 例肝功能异常。PV 支架置入后 PVP 梯度中位数为 3.0cmHO（范围，1.5-3.0），明显小于支架置入前的 15cmHO（中位数，2.5-25；P<0.01）。除 1 例因腹膜种植导致持续难治性腹水的患者外，14 例患者（93%）均获得临床成功，症状改善。在中位随访时间为 7.3 个月（范围，1.0-87）期间，2 例患者（14%）因支架内肿瘤生长而发生支架闭塞。整个队列的 1 年累积支架通畅率为 76%。
基于对通畅率的持久影响，我们认为 HPB 手术后 PV 狭窄的 PV 支架治疗安全且有益于改善症状。
