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| 腹腔引流液中含有肠液和肠道内容物的精准检验诊断(附1例报告) |
| 徐健,吴康,宋珊珊,陶慧娟,陈燕,王学,俞靖龙,周道银* |
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(海军军医大学(第二军医大学)长海医院实验诊断科, 上海 200433
*通信作者) |
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| 摘要: |
| 目的 通过对一例腹腔引流液是否含有肠液和肠道内容物进行精准检验诊断，探索适宜检验技术在精准检验诊断中的应用。方法 整合常用、简便、快速、有效的检验项目开展精准检验诊断。首先混匀腹腔引流液样本观察其性状；然后将样本离心，取上悬液检测生化项目淀粉酶和胆汁酸，取沉渣制备干片用于瑞吉染色、革兰染色行形态学检查，取沉渣制备湿片用于显微镜直接观察；最后对以上检验结果进行评价，并结合其他实验室检查结果以及临床和检验基本理论知识综合分析判断。结果 引流液常规形态学检查：外观呈棕黄色、浑浊、蛋白阳性（+++）、细胞溶解无法计数；涂片瑞吉染色及革兰染色镜检：涂片细胞溶解、可见大量杆菌及少量球菌、可见胆红素结晶、可见脂滴状物。引流液生化检测：引流液淀粉酶1120U/L，引流液胆汁酸25μmol/L，二者均高于患者自身血清对照的5倍。引流液沉渣湿片：检出植物细胞、植物纤维。结论 引流液沉渣湿片检出植物细胞、植物纤维是确认引流液含有肠道内容物的形态学诊断依据；引流液淀粉酶、胆汁酸检测结果均高于患者自身血清对照的5倍是提示引流液含有肠液的生化学诊断依据。运用多参数适宜检验技术能够对腹腔引流液是否含有肠液和肠道内容物作出精准检验诊断。 |
| 关键词: 腹腔引流液 检验诊断 肠道内容物 适宜检验技术 |
| DOI：10.16781/j.0258-879x.2019.11.1275 |
| 投稿时间：2019-04-18修订日期：2019-06-28 |
| 基金项目: |
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| Precision laboratory diagnosis of intestinal fluid and intestinal contents in peritoneal drainage fluid: a case report |
| XU Jian,WU Kang,SONG Shan-shan,TAO Hui-juan,CHEN Yan,WANG Xue,YU Jing-long,ZHOU Dao-yin* |
(Department of Laboratory Medicine, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective: To explore the clinical application of appropriate examination technology in precision laboratory diagnosis by testing whether there were intestinal fluid and intestinal contents in abdominal drainage fluid. Methods: Integrated common, simple, rapid and effective testing items to carry out precision laboratory diagnosis. First, the abdominal drainage liquid was mixed well and observed its appearance, then the specimen was centrifuged and separated the supernatant to detect the concentration of amylase and bile acid. The sediment was either taken for direct microscopic examination or prepared as dry slices for Gram dyeing. Finally, we draw a conclusion about whether there were intestinal contents based on the following results and other laboratory results.Results: Routine examination and morphology of the abdominal drainage fluid: the appearance was brown and turbid,Protein qualitative examination: positive (+++), cell lysis fragments was observed and thus the number of cells could not be counted. Microscopic results: Cells were lysed, a large number of bacteria and a small number of cocci were observed. Besides, there were also bilirubin crystals and lipid droplets. Biochemistry results: Amylase 1120U/L, bile acid 25μmol/L. Both the content of amylase and bile acid were 5 times to the patient’s own serum level respectively. Sediment results：The plant cells and plant fibers were found. Conclusion: The detection of plant cells, plant fibers in the wet sediment of drainage fluid is the basis for morphological diagnosis of intestinal contents in the drainage fluid.The results of amylase and bile acid in the drainage fluid were five times higher than those in the patient's own serum control, which was the basis for biochemical diagnosis of intestinal fluid. Therefore, the abdominal drainage fluid could be distinguished from intestinal fluid and intestinal contents by the above multi-parameter appropriate examination technology and results analysis. |
| Key words: peritoneal drainage fluid laboratory diagnosis intestinal contents appropriate examination technology |
