支架置入对恶性门静脉狭窄患者生存的影响：一项倾向评分匹配研究。
Effect of Stent Placement on Survival in Patients with Malignant Portal Vein Stenosis: A Propensity Score-Matched Study.
机构信息
Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Radiology, Chung-Ang University Health Care System, Hyundae Hospital, Namyangju, Korea.
出版信息
Korean J Radiol. 2022 Jan;23(1):68-76. doi: 10.3348/kjr.2021.0298.
OBJECTIVE
Percutaneous portal vein (PV) stent placement can be an effective treatment for symptoms associated with portal hypertension. This study aimed to evaluate the effect of PV stenting on the overall survival (OS) in patients with malignant PV stenosis.
MATERIALS AND METHODS
Two groups of patients with malignant PV stenosis were compared in this retrospective study involving two institutions. A total of 197 patients who underwent PV stenting between November 2016 and August 2019 were established as the stent group, whereas 29 patients with PV stenosis who were treated conservatively between July 2013 and October 2016 constituted the no-stent group. OS was compared between the two groups before and after propensity score matching (PSM). Risk factors associated with OS were evaluated using the Cox proportional hazards model. Procedure-associated adverse events were also evaluated.
RESULTS
The stent group finally included 100 patients (median age, 65 [interquartile range, 58-71] years; 64 male). The no-stent group included 22 patients (69 [61-75] years, 13 male). Stent placement was successful in 95% of attempted cases, and the 1- and 2-year stent occlusion-free survival rate was 56% (95% confidence interval, 45%-69%) and 44% (32%-60%), respectively. The median stent occlusion-free survival time was 176 (interquartile range, 70-440) days. OS was significantly longer in the stent group than in the no-stent group (median 294 vs. 87 days, < 0.001 before PSM, = 0.011 after PSM). The 1- and 3-year OS rates before PSM were 40% and 11%, respectively, in the stent group. The 1-year OS rate after PSM was 32% and 5% in the stent and no-stent groups, respectively. Anemia requiring transfusion (n = 2) and acute thrombosis necessitating re-stenting (n = 1) occurred in three patients in the stent group within 1 week.
CONCLUSION
Percutaneous placement of a PV stent may be effective in improving OS in patients with malignant PV stenosis.
目的
经皮门静脉（PV）支架置入术可有效治疗门脉高压相关症状。本研究旨在评估 PV 支架置入术对恶性 PV 狭窄患者总生存期（OS）的影响。
材料与方法
本回顾性研究在两家机构中比较了两组恶性 PV 狭窄患者。2016 年 11 月至 2019 年 8 月行 PV 支架置入术的 197 例患者为支架组，2013 年 7 月至 2016 年 10 月行保守治疗的 29 例 PV 狭窄患者为无支架组。在倾向评分匹配（PSM）前后比较两组 OS。采用 Cox 比例风险模型评估与 OS 相关的危险因素。还评估了与操作相关的不良事件。
结果
支架组最终纳入 100 例患者（中位年龄 65 [四分位距 58-71] 岁；64 例男性）。无支架组纳入 22 例患者（69 [61-75] 岁，13 例男性）。95%的尝试性支架置入术均获得成功，1 年和 2 年无支架闭塞生存率分别为 56%（95%置信区间，45%-69%）和 44%（32%-60%），中位无支架闭塞生存时间为 176（四分位距 70-440）天。支架组 OS 明显长于无支架组（中位 294 比 87 天，PSM 前<0.001，PSM 后=0.011）。PSM 前支架组 1 年和 3 年 OS 率分别为 40%和 11%，PSM 后分别为 32%和 5%。支架组有 3 例患者在 1 周内出现需要输血的贫血（n=2）和需要再次支架置入的急性血栓形成（n=1）。
结论
经皮 PV 支架置入术可能有效提高恶性 PV 狭窄患者的 OS。
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