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目的评价富士能智能电子分光技术(FICE)结合放大内镜在早期大肠癌诊断中的价值。方法 2010年1月至2011年12月经普通内镜发现存在大肠黏膜可疑病灶且符合研究要求的患者共325例,行FICE结合放大内镜及靛胭脂染色检查,部分病变结合放大内镜及实体显微镜观察腺管开口分型(pit分型)并与病理诊断对照,pit分型采用工藤分型。结果 396个病变中非肿瘤性病变占13.6%(54/396);各类腺瘤占76.0%(301/396),其中3例腺瘤恶变,占腺瘤的1.0%(3/301);进展期肠癌41例,占10.4%(41/301)。上述病变黏膜腺管开口类型分析显示在非肿瘤性病变中尤其增生性病变、炎性息肉绝大部分为Ⅰ、Ⅱ型腺管开口,占92.7%(38/41)。在肿瘤性病变中,管状腺瘤及管状绒毛腺瘤之腺管开口以ⅢL型为主,而绒毛状腺瘤则以Ⅳ型为多见。在进展期癌中,无1例外地表现为腺管开口的破坏,甚至无腺管结构。将FICE结合放大内镜及靛胭脂染色检查结果及病理检查结果进行统计得出:FICE结合放大内镜诊断早期大肠癌的诊断符合率、敏感性、特异性、假阳性率、假阴性率分别为97.8%(361/396)、92.6%(38/41)、99.4%(353/355)、92.6%(38/41)、99.4%(353/355);靛胭脂染色诊断早期大肠癌的诊断符合率、敏感性、特异性分别为97.7%(390/396)、87.8%(36/41)、98.9%(351/355)、1.12%(4/355)、12.3%(5/41);二者比较差异均无统计学意义(P均>0.05)。结论 FICE结合放大内镜可以提供清晰的大肠黏膜血管图像,有助于早期大肠癌的诊断,可提高活检检查的准确性,与靛胭脂染色联用可提高早期大肠癌的诊断率。
Objective To evaluate the value of FICE combined with magnifying endoscopy in the diagnosis of early colorectal cancer. Methods From January 2010 to December 2011, 325 patients with suspicious lesions of colorectal mucosa were found by ordinary endoscopy and were in line with the research requirements. FICE combined with magnifying endoscopy and indigo dyeing examination, some lesions combined with magnifying endoscopy and solid-state microscope Observation of open duct type (pit type) and pathological diagnosis control, Pit type using Kudo type. Results Among the 396 lesions, non - neoplastic lesions accounted for 13.6% (54/396). All kinds of adenomas accounted for 76.0% (301/396), of which 3 cases had adenomas (1.0% (3/301)). 41 cases of advanced colorectal cancer, accounting for 10.4% (41/301). The above analysis showed that in the non-neoplastic lesions especially hyperplastic lesions, the majority of inflammatory polyps were type I and type II duct openings, accounting for 92.7% (38/41). In neoplastic lesions, the tubular openings of tubular adenoma and tubular villous adenoma are mainly type IIIL, whereas type of villous adenoma is more common than type IV. In the advanced stage of cancer, none of the cases showed the destruction of the duct opening, or even no duct structure. FICE combined with magnifying endoscopy and indigo carmine staining test results and pathological findings were calculated: FICE combined with magnifying endoscopy diagnosis of early colorectal cancer coincidence rate, sensitivity, specificity, false positive rate, false negative rate were 97.8% (361/396), 92.6% (38/41), 99.4% (353/355), 92.6% (38/41) and 99.4% (353/355), respectively. The diagnosis of early colorectal cancer was indigo rouge staining The sensitivity, specificity were 97.7% (390/396), 87.8% (36/41), 98.9% (351/355), 1.12% (4/355), 12.3% (5/41) There was no significant difference between the two groups (P> 0.05). Conclusion FICE combined with magnifying endoscopy can provide a clear image of large intestinal mucosa, which is helpful for the diagnosis of early colorectal cancer and improves the accuracy of biopsy. Combined with indigo carmine staining can improve the diagnosis rate of early colorectal cancer.