腹腔引流液胆红素及淀粉酶测定早期诊断术后小肠瘘  

Bilirubin and amylase in abdominal drainage for early dignosis of postoperative intestinal fistula

作　　者：闫东红[1] 陈智年[1] 徐兵[1] 刘松杰[1] 张观朝[1] 魏定夏[1] 张桂凌[1] 王兆刚[1] 刘衍民[2] 

机构地区：[1]新乡市中心医院普外科,河南新乡453000 [2]广州医学院第一附属医院微创外科中心普外科,广东广州510230

出　　处：《广州医学院学报》2012年第6期44-46,共3页Academic Journal of Guangzhou Medical College

摘　　要：目的:探讨腹腔引流液胆红素和淀粉酶早期诊断小肠瘘的可行性。方法:回顾性分析2006年7月至2011年3月新乡市中心医院收治的58例胃肠道手术患者的临床资料,术后检测分析腹腔引流液和血液中的胆红素、淀粉酶水平与小肠瘘的关系。结果:58例患者中确诊为小肠瘘者26例,腹腔引流液和血液胆红素分别为(241.35±107.81)μmol/L和(44.26±8.17)μmol/L,两者比较,差异有统计学意义(P<0.01);腹腔引流液和血液淀粉酶分别为(4086.00±1726.32)μmol/L和(63.40±16.42)μmol/L,两者比较,差异有统计学意义(P<0.01)。无小肠瘘者32例,腹腔引流液和血液胆红素分别为(15.34±6.28)μmol/L和(41.22±5.64)μmol/L,两者比较,差异有统计学意义(P<0.01);腹腔引流液和血液淀粉酶分别为(34.85±5.64)μmol/L和(42.62±7.83)μmol/L,两者比较,差异有统计学意义(P<0.01);腹腔引流液胆红素和淀粉酶早期诊断时间为术后(4.48±1.18)d,确诊时间为术后(6.29±1.04)d,二者比较,差异有统计学意义(P<0.01);对肠瘘诊断的敏感性为92.31%、特异性为90.63%、准确性为91.31%,与传统的确诊方法相比,差异无统计学意义(P>0.05)。结论:腹腔引流液胆红素和淀粉酶明显高于血清胆红素与淀粉酶提示小肠瘘,用此方法可早期诊断小肠瘘。Objective： To assess the feasibility of bilirubin and amylase in abdominal drainage for early diagnosis of postoperative intestinal fistula. Methods： We did a retrospective analysis on 58 patients received surgery of the gastrointestinal tract who were admitted to the Department of General Surgery, XinXiang Central Hospital between July 2006 and March 2011. The bilirubin and amylase obtained from the abdominal drainage were assayed postoperatively to determine the correlation with intestinal fistula. Results： Of 58 patients enrolled, 26 were diagnosed as having intestinal fistula, in whom higher level of bilirubin （ P 〈 0. 01 ） in drainage was noted [ （241.35 ± 107.81 ）μmol/L] when compared with that in serum [ （24.26 ± 8.17）μmol/L]. A higher level of amylase in drainage was found [ （4086.00 ± 1726.32） μmol/L ] when compared with that in serum [ （63.40± 16.42） μ/L, P 〈 0.01 ]. In those without intestinal fistula, the level of amylase was lower in the drainage [ （34.85 ± 5.64.11 ） μmol/L], but not in serum [ （42.62± 7.83 ） μmol/L, P 〈 0.01 ]. The level of bilirubin differed statistically in the drainage [ （15.34±6.28） μmol/L] and in serum [ （41.22±5.64 μmol/L, P 〈0.01 ]. For assaying with bilirubin and amylase, the time to early diagnosis [ （4.48±1.18 ） days ] wasshortened （P 〈 0.01 ） compared with that of conventional confirmed diagnosis [ （6.29 ± 1.04） days ]. This yielded an assay sensitivity, specificity and accuracy of 92.31%, 90.63 % and 91.31% （ all P 〉 0.05 compared with those of conventional approaches）. Conclusion： Higher levels of bilirubin and amylase in the abdominal drainage are indicative of postoperative intestinal fistula and may be employed for the early diagnosis.

关 键 词：小肠瘘 胆红素 淀粉酶 

分 类 号：R635[医药卫生—外科学]