论文部分内容阅读
目的探讨窄带成像技术(narrow-banding imaging,NBI)在早期食管癌及其癌前病变诊断中的临床应用价值。方法在白光和 NBI 模式下观察食管黏膜,记录病变的大小、范围,同时进行NBI 分级。再应用 NBI 结合放大内镜观察病变部位上皮乳头内毛细血管袢(intrapapillary capillaryloop,IPCL)形态,同时进行 IPCL 形态分型。最后应用1.2%碘液进行全食管染色,记录碘染色阳性部位大小、范围,并进行碘染色分级。对于 NBI 模式阴性而碘染色阳性的病变,再次应用 NBI 结合放大内镜进行检查。对所有 NBI 阳性及碘染色阳性部位均取活检。以病理结果作为诊断金标准,将其他检查结果与之作对照。结果 (1)应用白光、NBI 模式及碘染色检查72例患者中共发现104个病变。其中白光模式下,高年资和低年资内镜医师对病变检出率分别为82.7%(86/104)和70.2%(73/104);应用 NBI 模式及碘染色后两位医师对病变的检出率相同,NBI 模式均为86.5%(90/104),碘染色均为100.0%。(2)所有高级别黏膜内瘤变碘染色阳性,其中83.0%(39/47)碘染色分级为Ⅰ级;所有低级别黏膜内瘤变碘染色也为阳性,但其中87.2%(41/47)碘染色分级为Ⅱ、Ⅲ级。(3)91.5%(43/47)高级别黏膜内瘤变 NBI 阳性,其中69.8%(30/43)NBI 分级为Ⅰ级;57.4%(27/47)低级别黏膜内瘤变 NBI 阳性,其中85.2%(23/27)NBI 分级为Ⅱ、Ⅲ级。(4)93.6%(44/47)高级别黏膜内瘤变IPCL 形态异常,其中88.6%(39/44)IPCL 分型为Ⅳ、Ⅴ型;76.6%(36/47)低级别黏膜内瘤变 IPCL 形态异常,其中77.8%(28/36)IPCL 分型为Ⅱ、Ⅲ型。结论与白光模式相比,NBI 模式与碘染色均可增强病变的识别性,提高内镜医师对病变的检出率。NBI 结合放大内镜可提高对高级别黏膜内瘤变诊断的符合率,效果与碘染色相当。NBI 在早期食管癌及癌前病变诊断有一定的临床应用价值。
Objective To investigate the clinical value of narrow-band imaging (NBI) in the diagnosis of early esophageal cancer and its precancerous lesions. Methods The esophageal mucosa were observed under white light and NBI mode. The size and range of lesion were recorded, and the NBI classification was performed at the same time. NBI combined with magnifying endoscopy was used to observe the morphology of intraepithelial capillary loop (IPCL) in the lesion and IPCL morphological typing. The final application of 1.2% iodine solution for total esophageal staining, record the size and extent of positive iodine staining sites, and iodine staining grading. Negative NBI mode iodine staining positive lesions again NBI combined with magnifying endoscopy to check. All biopsies were taken from all positive NBI-positive and iodine-stained sites. Pathological results as the gold standard for diagnosis, the other test results with the control. Results (1) A total of 104 lesions were found in 72 patients using white light, NBI mode and iodine staining. Among white-light modes, the detection rates of high-grade and low-grade endoscopists were 82.7% (86/104) and 70.2% (73/104), respectively. The NBI mode and iodine staining showed that the lesions were detected by two physicians The detection rates were 86.5% (90/104) in NBI mode and 100.0% in iodine staining. (2) Iodine staining was positive in all high grade mucosal neoplasms, of which 83.0% (39/47) were classified as grade I; all low grade mucosal neoplasia was positive for iodine staining, but 87.2% (41/47) ) Iodine staining grade Ⅱ, Ⅲ grade. (3) In 91.5% (43/47) high grade mucosal neoplasia, NBI was positive, of which 69.8% (30/43) had NBI grade Ⅰ and 57.4% (27/47) low grade mucosal neoplasia NBI positive 85.2% (23/27) NBI grade Ⅱ, Ⅲ grade. (4) 93.6% (44/47) of the high grade mucosal neoplasia had morphological abnormalities of IPCL, of which 88.6% (39/44) were classified as type IV and type Ⅴ; 76.6% (36/47) were low grade mucosal neoplasia IPCL morphological abnormalities, of which 77.8% (28/36) IPCL type Ⅱ, Ⅲ type. Conclusion Compared with white light, NBI mode and iodine staining can enhance the identification of lesions and improve the detection rate of lesions by endoscopists. NBI combined with magnifying endoscopy can improve the diagnosis of high-grade intramucosal neoplasia coincidence rate, the effect is equivalent to iodine staining. NBI in the early diagnosis of esophageal cancer and precancerous lesions have some clinical value.