Department of Surgery, Dentistry, Gynecology and Pediatrics, Division of General and Hepatobiliary Surgery, University of Verona, G.B. Rossi University Hospital, P. le L.A. Scuro 10, 37134, Verona, Italy.
Department of Diagnostics and Public Health, Unit of Radiology, University of Verona, G.B. Rossi University Hospital, P. le L.A. Scuro 10, 37134, Verona, Italy.
Eur J Surg Oncol. 2024 Mar;50(3):107984. doi: 10.1016/j.ejso.2024.107984. Epub 2024 Jan 30.
Recurrent or locally advanced peri-hilar cholangiocarcinoma (PHCC) usually involves the portal vein (PV) leading to significant stenosis. With disease progression, clinical symptoms such as ascites, bleeding, and hepatic insufficiency are usually observed. Little is know about the benefit of PV stenting in relieving the symptoms associated to portal hypertension and allowing anticancer therapies. The aim of this study is to review our experience in PV stenting for PHCC patients.
From 2014 to 2022, data from PHCC patients underwent PV stenting at Verona University Hospital, Italy, were reviewed. The indications were: gastrointestinal bleeding from esophagus-gastric varices, ascites not responsive to medical therapy, severe thrombocytopenia, liver insufficiency (hepatic jaundice, coagulopathy, and/or hyperammoniemia), or asymptomatic high-grade PV stenosis. Cavernous transformation and intrahepatic thrombosis in both sides of the liver were considered contraindication. Systematic anticoagulation therapy was not administered.
Technical success was achieved in all 16 (100 %) patients. The improvement of clinical symptoms were observed in 12 (75 %) patients. Anticancer therapy was administrated in 11 (69 %) patients. 2 (13 %) complications were observed: 1 biliary injury and 1 recurrent cholangitis that required a percutaneous trans-hepatic biliary drainage placement. Stent occlusion for tumor progression occurred in 1 patient and a re-stenting procedure was successfully performed. No case of thrombotic stent occlusion was observed during follow up. The 1-year stent patency was 86 % and the median patency period was 8 months (IQR, 4-12).
PV stenting is a feasible and safe palliative treatment that improves clinical condition, allow anticancer therapies, and provide a better quality of life.
复发性或局部晚期肝门部胆管癌（PHCC）通常累及门静脉（PV），导致明显狭窄。随着疾病的进展，通常会出现腹水、出血和肝功能不全等临床症状。对于 PV 支架置入术在缓解门静脉高压相关症状并允许进行抗癌治疗方面的益处知之甚少。本研究旨在回顾我们在 PHCC 患者中进行 PV 支架置入术的经验。
2014 年至 2022 年，回顾了在意大利维罗纳大学医院接受 PV 支架置入术的 PHCC 患者的数据。适应证为：食管胃静脉曲张出血、对药物治疗无反应的腹水、严重血小板减少、肝功能不全（肝黄疸、凝血功能障碍和/或高血氨）或无症状的高级别 PV 狭窄。肝内血栓形成和双侧海绵状转化被认为是禁忌证。未进行系统抗凝治疗。
所有 16 例（100%）患者均获得技术成功。12 例（75%）患者的临床症状得到改善。11 例（69%）患者接受了抗癌治疗。观察到 2 例（13%）并发症：1 例胆道损伤和 1 例复发性胆管炎，需要经皮经肝胆道引流。1 例因肿瘤进展导致支架阻塞，并成功进行了再支架置入术。在随访期间未观察到血栓性支架阻塞。1 年支架通畅率为 86%，中位通畅期为 8 个月（IQR，4-12）。
PV 支架置入术是一种可行且安全的姑息性治疗方法，可改善临床状况，允许进行抗癌治疗，并提供更好的生活质量。
