目的：探讨内镜窄带成像技术（NBI）对早期食管癌诊断的优势和意义。方法选取我院2012年1月至2015年8月收治的100例疑似早期食管癌患者为研究对象。所有研究对象依次进行白光、NBI、碘染下放大观察，获取清晰图像，评价每一种检查方式下患者病变部位的轮廓、浅表性毛细血管结构形态图像的可见度及清晰度，后由操作者对 NBI 观察到的上皮乳头内毛细血管袢（IPCL）进行分型，并在病变最为明显的地方取2～4块活体组织送病理组织学检查。结果病变形态清晰度方面，NBI 放大＞染色放大＞白光放大，与后两者比较，NBI 放大的清晰度评分均显著较高（P ＝0.000、P ＝0.005）。IPCL 对食管炎症组的诊断特异性为96.8％，灵敏度为87.7％，阳性预测值为92.8％，IPCL 分型主要见于Ⅱ型（12／18）。IPCL 对低级别上皮内瘤变组的诊断特异度为96.5％，灵敏度为87.7％，阳性预测值为85.7％，IPCL 分型主要见于Ⅲ型（22／35）。高级别上皮内瘤变组 IPCL 分型均见于Ⅳ型（24／24）。IPCL 对早期食管癌的诊断特异度为87.4％，灵敏度为84.3％，阳性预测值为78.9％，主要见于 V-1、V-2型（14／23）。结论窄带成像技术结合放大内镜（ME-NBI）与白光放大、染色放大下 NBI 放大内镜观察病变形态的清晰度较高，借助 NBI 放大观察的 IPCL 分型，可准确判断病变的性质及癌组织浸润的深度，具有良好的诊断应用价值。%Objective To explore the advantages and significance of endoscopic narrow band imaging in the diagnosis of early esophageal cancer.Methods One hundred cases of patients with suspected early esophageal cancer,who were admitted in our hospital between January 2012 and August 2015,were selected as the study sub-jects.All the subjects underwent white light,NBI and iodine,staining magnifying observation and clear images were obtained.The visibility and legibility of images of diseased region outline and superficial capillary structure displayed by different detection methods were evaluated.Then,IPCL observed by NBI was typed by the manipu-lator.2-4 pieces of tissues were taken from the most obvious diseased site for histopathologic examination.Results In terms of lesion morphological legibility,it showed NBI magnification > staining magnification > white light magni-fication.Compared with the latter two,the score of legibility magnified by NBI was significantly higher (P=0.000,P=0.005).The specificity,sensitivity and positive predictive value of IPCL in the diagnosis of esophagitis were 96.8%,87.7% and 92.8%,respectively.IPCL typing was mainly found in type Ⅱ (12/18).The specificity, sensitivity and positive predictive value of IPCL in the diagnosis of low grade intraepithelial neoplasia were 96.5%, 87.7% and 85.7%,respectively and the IPCL typing was mainly found in type Ⅲ (22/35).IPCL typing in high grade intraepithelial neoplasia was found in type Ⅳ (24/24).The specificity,sensitivity and positive predictive value of IPCL in the diagnosis of early esophageal cancer were 87.4%,84.3% and 78.9%,respectively and main-ly in type V-1 and V-2 (14/23).Conclusion The legibility of images of lesion shapes displayed by ME-NBI and white light amplification,NBI magnifying endoscopy under staining magnification is relatively higher.With the help of IPCL typing observed by NBI magnification,the nature of lesions and depth of cancer tissue infiltration can be accurately judged.It has good diagnostic application value.
展开▼
