Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, 683-8504, Japan.
Surg Today. 2023 Jul;53(7):773-781. doi: 10.1007/s00595-023-02645-5. Epub 2023 Jan 29.
This study was performed to investigate the predictive value of the perioperative D-dimer concentration for the development of postoperative deep vein thrombosis (DVT) after hepatobiliary-pancreatic (HBP) surgery.
The subjects of this retrospective study were 178 patients who underwent HBP surgery in our hospital between January, 2017 and December, 2021. The D-dimer concentration was measured preoperatively and on postoperative days (POD) 1, 3, and 5. Postoperative DVT was diagnosed based on compression ultrasonography in both lower limbs on POD 6 or 7.
Postoperative DVT developed in 21 (11.8%) of the 178 patients. The D-dimer concentration was significantly higher in the patients with than in those without postoperative DVT before surgery and on PODs 1, 3, and 5. The highest area under the curve of the D-dimer concentration for predicting DVT was 0.762 on POD 3. Multivariate analysis revealed that the D-dimer concentration on POD 3 was an independent predictive risk factor for postoperative DVT, along with the preoperative estimated glomerular filtration rate. Preoperative albumin and D-dimer concentrations were also identified as independent predictive factors of an increase in D-dimer concentration on POD 3.
The D-dimer concentration on POD 3 is a useful predictor of DVT after HBP surgery.
本研究旨在探讨围手术期 D-二聚体浓度对肝胆胰（HBP）手术后深静脉血栓形成（DVT）发展的预测价值。
本回顾性研究的对象为 2017 年 1 月至 2021 年 12 月在我院接受 HBP 手术的 178 例患者。术前及术后第 1、3、5 天测定 D-二聚体浓度。术后第 6 或 7 天行双下肢压迫超声诊断 DVT。
178 例患者中，21 例（11.8%）发生术后 DVT。与无术后 DVT 患者相比，术前及术后第 1、3、5 天，DVT 患者的 D-二聚体浓度明显升高。预测 DVT 的 D-二聚体浓度的最佳曲线下面积为术后第 3 天的 0.762。多变量分析显示，术后第 3 天的 D-二聚体浓度与术前估算肾小球滤过率是术后 DVT 的独立预测危险因素。术前白蛋白和 D-二聚体浓度也是术后第 3 天 D-二聚体浓度升高的独立预测因素。
术后第 3 天的 D-二聚体浓度是 HBP 手术后 DVT 的一个有用预测指标。
