术前 D－二聚体水平对胰头癌可切除性的诊断价值

摘要

目的：评估术前 D－二聚体测值水平对胰头癌可切除性的诊断价值。方法纳入64例术前影像学评估能够根治性切除的胰头癌患者，术前留取外周血及尿液标本，术中留取门静脉血及胆汁标本，测试四种标本的 D－二聚体值。根据术中探查，29例患者确认能够接受根治性的胰十二指肠切除术（根治组），35例术中确认肿瘤不能切除而选择姑息性手术方式（姑息组）。比较根治组与姑息组患者之间 D－二聚体水平的差异，并绘制受试者工作特征（ROC）曲线，计算这一指标的最佳临界值的敏感性及特异性。结果姑息组的外周血及门静脉血的 D－二聚体水平均较根治组高（P ＜0．05）。术前 D－二聚体以570．6μg／L 为最佳临界值，其敏感性及特异性分别为82．8％及66．6％。有肝脏转移的15例患者外周血 D－二聚体值明显高于肿瘤侵犯肠系膜血管的20例患者（P ＝0．029），其 ROC 曲线下面积更大（0．87）；以769．8μg／L 为最佳诊断阈值，其敏感性和特异性分别为86．6％和80％。结论对于术前影像学检查评估为可根治性切除的胰头癌患者，如果 D－二聚体值明显升高，预示着肝脏存在术前检查难以发现的微小转移灶。这类患者选择行诊断性的腹腔镜下超声探查可以避免不必要的剖腹探查手术。%Objective To assess the diagnostic value of preoperative D -dimers level for resectability of pancreatic head canc -er.Methods Sixty-four patients who could be undergone a radical resection of pancreatic head carcinoma estimated with preoperative radiographic evaluation were selected .Preoperative peripheral blood samples ,urine specimens,specimens from the portal venous blood and bile samples were tested for D-dimer levels.According to the intraoperative findings ,29 patients were confirmed to receive the radi -cal resection of pancreas and duodenum (radical group)and 35 patients were confirmed to be tumor unresectable and underwent pallia -tive operation(palliative group).Differences in D-dimer levels between the curative group and palliative group were compared .Receiver operating characteristic(ROC)curve analysis was used to determine the sensitivity and specificity of the index .Results The mean D-dimer values in peripheral and portal blood in the palliative group were significantly higher than that in the radical group .If 570.6 μg/L of preoperative D-dimer value was taken as the cut -off value,sensitivity and specificity for assessment of tumor unresectability was 82.8%and 66.6%,respectively.Moreover,peripheral blood D-dimer values in patients with liver metastases (n =15)were significantly higher than that in patients with tumor invasion of mesenteric vessels (n=20)(P =0.029).The area under ROC curve for these cases was 0.87 with 86.6%sensitivity and 80%specificity when 769.8 μg/L of D-dimer value was taken as the cut-off value.Conclusion Elevated preoperative D-dimers may predict occult hepatic metastases and unresectability of pancreatic head tumor .These patients should undergo diagnostic laparoscopy and /or laparoscopic ultrasound to assess resectability approaches .