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目的:评价窄带成像技术(NBI)联合碘染色对早期食管癌及其癌前病变的诊断及超声内镜在指导食管早癌治疗的价值。方法:2012年7月至2016年1月行普通白光胃镜检查怀疑食管黏膜病变的可疑患者为研究对象,共96例,分别行NBI检查、碘染色及在NBI褐色区、碘染色淡染区或不染区行病理检查,检测三种方法的灵敏度、特异度及准确率。对病理示癌变或癌前病变者在NBI或碘染色定位后行超声内镜检查,根据超声内镜病变浸润程度选择内镜黏膜切除术(EMR)、内镜黏膜下剥离术(ESD)或外科手术治疗,切除病变整体送检,比较病变浸润深度与超声判断的浸润深度的符合率。结果:早期食管癌检出率NBI为100%(10/10),碘染色为100%(10/1O),先NBI后碘染色亦为100%(10/10),三者差异无统计学意义(P>0.05)。高级别上皮内瘤变NBI、碘染色及联合两种方法的检出率分别为(47/50)、100%(50/50)和100%(50/50),三者间差异无统计学意义(P>0.05);低级别上皮内瘤变NBI、碘染色的检出率分别为75%(27/36)、83.3%(30/36)及94.4%(34/36),联合两种方法活检率明显高于NBI及碘染色法(P<0.01)。超声提示局限于粘膜层及侵及粘膜下层而无淋巴结转移者或虽病变突破粘膜下层但有其他基础病无法手术或不愿接受外科手术的患者,行ESD或EMR,对于病变已侵及肌层及有转移者,行外科手术治疗,切除病变整体送检,病理病变浸润深度与超声判断的浸润深度的符合率为91.4%。结论:NBI、碘染色内镜及联合两种方法对早期食管癌均有较好的诊断价值,对于癌前病变中的高级别上皮内瘤变三者诊断价值相近,但对于低级别上皮内瘤变NBI联合碘染色诊断价值高于NBI及碘染色。
Objective: To evaluate the value of narrow band imaging (NBI) combined with iodine staining in the diagnosis of early esophageal cancer and its precancerous lesions and the value of endoscopic ultrasonography in the treatment of early esophageal cancer. Methods: From July 2012 to January 2016, suspicious patients suspected of esophageal mucosal lesions underwent routine white light gastroscopy were studied. A total of 96 patients were examined by NBI, iodine staining and light brown staining in NBI, Not stained line pathological examination, detection of three methods of sensitivity, specificity and accuracy. Pathological changes of cancer or precancerous lesions in the NBI or iodine staining after positioning ultrasound endoscopy, according to the degree of endoscopic ultrasound infiltration of endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD) or surgery Surgical treatment, resection of the lesion as a whole, the lesion depth compared with the depth of ultrasound to determine the compliance rate. Results: The detection rates of early esophageal cancer were 100% (10/10), 100% (10/10) for iodine staining and 100% (10/10) for iodine staining after NBI. There was no statistical difference among the three groups Significance (P> 0.05). The detection rates of high grade intraepithelial neoplasia (NBI), iodine staining and the combination of the two methods were (47/50), 100% (50/50) and 100% (50/50) respectively, with no significant difference among the three (P> 0.05). The detection rates of NBI and iodine staining in low grade intraepithelial neoplasia were 75% (27/36), 83.3% (30/36) and 94.4% (34/36), respectively The biopsy rate was significantly higher than that by NBI and iodine staining (P <0.01). Ultrasound tips confined to the mucosa and invasion of the underlying submucosa without lymph node metastasis, or even if the lesions break through the submucosa but there are other underlying diseases inoperable or unwilling to accept surgery in patients with ESD or EMR, lesions have been invading the muscular layer And metastasis, surgical treatment, resection of the lesion as a whole, the depth of pathological lesions infiltration depth and ultrasound to determine the compliance rate of 91.4%. Conclusion: NBI, iodine staining endoscopy and combined with the two methods of early esophageal cancer have a good diagnostic value, for the precancerous lesions in the high-grade intraepithelial neoplasia diagnostic value of three similar, but for low-grade intraepithelial neoplasia NBI combined with iodine staining diagnostic value is higher than NBI and iodine staining.