Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan.
Langenbecks Arch Surg. 2021 May;406(3):883-892. doi: 10.1007/s00423-020-02058-9. Epub 2021 Jan 6.
The aim of this study was to evaluate the clinical utility of a novel diagnostic algorithm based on serum D-dimer levels for venous thromboembolism (VTE) after hepatectomy.
We retrospectively analyzed 742 consecutive patients who underwent hepatectomy in our hospital from 2009 to 2019. From 2015, we routinely measured serum D-dimer level postoperatively and computed tomography was performed when D-dimer level was ≥ 20 μg/mL.
VTE was diagnosed in 26 patients and pulmonary embolism (PE) was diagnosed in 18 patients. Multivariate analysis revealed that resected liver weight ≥ 120 g is a significant predictor of VTE (P = 0.011). The incidence of VTE from 2015 to 2019 was greater than that from 2009 to 2014 (5.0% versus 2.1%, P = 0.044). The number of low-risk PE patients between 2015 and 2019 was significantly greater than that between 2009 and 2014 (P = 0.013). There was no in-hospital mortality of patients with PE from 2015 to 2019.
Patients who undergo hepatectomy are at high risk for VTE, especially when the resected liver weight is high. The proposed diagnostic algorithm based on serum D-dimer levels for VTE after hepatectomy can be useful for early diagnosis.
本研究旨在评估一种基于血清 D-二聚体水平的新型诊断算法在肝切除术后静脉血栓栓塞症（VTE）中的临床应用价值。
我们回顾性分析了 2009 年至 2019 年在我院行肝切除术的 742 例连续患者。自 2015 年起，我们常规术后测量血清 D-二聚体水平，当 D-二聚体水平≥20μg/mL 时行 CT 检查。
26 例患者诊断为 VTE，18 例患者诊断为肺栓塞（PE）。多因素分析显示，切除肝脏重量≥120g 是 VTE 的显著预测因子（P=0.011）。2015 年至 2019 年 VTE 的发生率高于 2009 年至 2014 年（5.0%比 2.1%，P=0.044）。2015 年至 2019 年低危 PE 患者数量明显多于 2009 年至 2014 年（P=0.013）。2015 年至 2019 年 PE 患者无院内死亡。
肝切除术后患者 VTE 风险较高，尤其是当切除肝脏重量较高时。基于血清 D-二聚体水平的新型诊断算法可用于 VTE 的早期诊断。
