【摘要】 目的通过白光模式、窄带成像技术(NBI)及卢戈染色方法对食管病变进行内镜观察,比较这3种模式诊断早期食管癌及癌前病变的临床应用价值。方法 2010年1月至2013年1月在南京医科大学第一附属医院消化内科均行白光模式、NBI模式及卢戈染色内镜检查共103例患者125个病灶,包括食管炎症病灶16个,轻、中、重度不典型增生病灶44、25、22个,早期食管癌病灶18个。对所有NBI阳性及卢戈染色阳性部位均取活检。以手术病理结果作为诊断金标准,3种模式对病变的检出率比较应用χ2检验,病变NBI分级及卢戈染色分级与病理结果比较应用χ2检验。结果 (1)103例患者内镜检查共发现125个病灶,其中白光模式下、NBI模式下及卢戈染色后分别发现早期食管癌及癌前病变85个(68.0%)、105个(84.0%)、109个(87.2%);NBI模式下和卢戈染色对于早期食管癌及癌前病变的检出率差异无统计学意义,白光模式下早期食管癌及癌前病变的检出率均低于NBI模式下和卢戈染色后,且差异有统计学意义(χ2=8.772,P=0.003;χ2=13.255,P=0.000)。(2)NBI模式下及卢戈染色诊断重度不典型增生和早期食管癌的敏感度均为100%(40/40),均高于白光模式下的85.0%(34/40),且差异均有统计学意义(χ2均=4.505,P均=0.026);NBI模式下及卢戈染色诊断轻-中度不典型增生的敏感度分别为94.2%(65/69)、100%(69/69),两者之间比较差异无统计学意义,但两者均高于白光模式下诊断轻-中度不典型增生的敏感度73.9%(51/69),且差异均有统计学意义(χ2=10.599,P=0.001;χ2=20.700,P=0.000)。重度不典型增生和早期食管癌病灶NBI分级、卢戈染色分级均多为Ⅰ级[90.0%(36/40)、95.0%(38/40)],轻-中度不典型增生病灶NBI分级、卢戈染色分级均多为Ⅱ、Ⅲ级[均为94.2%(65/69)],且差异均有统计学意义(χ2=18.373、23.736、39.371、39.371,均P=0.000)。结论 NBI模式和卢戈染色均能够更清晰地显示早期食管癌及癌前病变的范围和大小,有助于更精确的活检,从而提高病变的检出率,且两者对于早期食管癌及癌前病变的诊断效能相似,均明显优于白光模式。NBI模式和卢戈染色可作为诊断早期食管癌的互补手段。更多还原

【Abstract】 Objective To compare the clinical application value of white light imaging( WLI),narrow-band imaging( NBI) and Lugol’ s iodine staining in the diagnosis of early esophageal cancer and precancerous lesions. Methods One hundred and three patients were enrolled from January 2010 to January2013. Esophageal mucosa was examined by first using WLI,second NBI,and third after Lugol’ s iodine staining. One hundred and twenty-five lesions which included 16 esophageal inflammatory,44 mild dysplasia,25 moderate dysplasia and 22 severe dysplasia,18 early esophageal cancer were found. All lesions were confirmed by pathologic diagnosis as the gold standard. Then the detection rates of the 3 modes and other related indicators were compared. While the NBI grading and Lugol’s iodine staining classification of the lesions were compared with pathological diagnosis. Results( 1) One hundred and twenty-five lesions were found in 103 patients. The WLI,NBI and Lugol’s iodine staining detected 85( 68. 0%),105( 84. 0%)and 109( 87. 2%) early esophageal cancer and precancerous lesions respectively. There was no significant difference between NBI and Lugol’ s iodine staining in detecting rate. The detection rate of WLI was lower than NBI and Lugol’s iodine staining,and differences were statistically significant( χ2= 8. 772,P = 0. 003;χ2= 13. 255,P = 0. 000).( 2) Both the sensitivities for severe dysplasia and early esophageal cancer of NBI and Lugol’s iodine staining were 100%( 40 /40),which were apparently higher than WLI 85. 0%( 34 /40)( both χ2= 4. 505,P = 0. 026). There was no significant difference in detecting mild and moderate dysplasia between NBI and Lugol’s iodine staining [94. 2%( 65 /69) vs 100%( 69 /69) ],both of which were higher than WLI 73. 91%( 51 /69)( χ2= 10. 599,P = 0. 001; χ2= 20. 700,P = 0. 000). NBI grading and Lugol’s iodine staining grading for severe dysplasia and early esophageal cancer lesions were mostly grade Ⅰ[90. 0%( 36/40),95. 0%( 38/40) ],and for mild and moderate dysplasia lesions were mostly grade Ⅱand Ⅲ [both were 94. 2%( 65 /69) ],and differences were statistically significant( χ2= 18. 373,23. 736,39. 371,39. 371,all P = 0. 000). Conclusions NBI and Lugol’s iodine staining are able to show the scope and size of early esophageal cancer and precancerous lesions more clearly,contribute to a more accurate biopsy,thereby enhancing lesion detection rate. NBI appears as effective as Lugol’s iodine staining to detect early esophageal cancer and precancerous lesions,and they are significantly better than WLI. NBI and Lugol’s iodine staining can be used as a complementary means to diagnose early esophageal cancer.更多还原