【摘要】 目的探讨内镜窄带成像(NBI)技术在早期食管癌、下咽癌诊断中的临床应用价值,明确食管和下咽部重复癌的发病情况。方法对78例下咽部或食管病变患者,用内镜分别在白光和NBI模式下观察,进行NBI分级;再用鲁氏碘液进行食管、下咽部染色并进行碘液染色分级。以活组织检查或术后病理结果作为诊断标准,评估白光、NBI和碘染色诊断早期癌和癌前病变的灵敏度、特异度和正确指数。结果 3种方法共检出病变86处,其中经病理检查证实为早期鳞状细胞癌(以下简称为鳞癌)和癌前病变40处。NBI诊断早期癌和癌前病变的灵敏度和特异度分别为0.85和0.89,碘液染色诊断早期癌和癌前病变的灵敏度和特异度分别为0.80和0.91,均显著优于白光(灵敏度和特异度分别为0.65和0.50,P值均<0.05)。NBI分级、碘液染色分级与病理诊断分级一致性较好(Kappa值分别为0.684和0.662)。共发现6处重复癌,其中4处为下咽癌、2处为胃癌。结论 NBI模式诊断下咽部、食管早期癌及其癌前病变的能力优于白光内镜。NBI分级与病理诊断分级的吻合度较好。食管鳞癌的患者可能会发生下咽鳞癌重复癌。更多还原

【Abstract】 Objective To explore the clinical value of the narrow-band imaging(NBI)endoscopy in early diagnosis of hypopharyngeal and esophageal cancer and to investigate the clinic characters of hypopharyngeal cancer and multiplicity esophageal cancer.Methods A total of 78 patients with hypopharyngeal or esophageal lesions were enrolled in this study.The suspicious lesions were observed under endoscopy in the white light and NBI models and graded by NBI.Then the esophagus and hypopharynx were dyed with Lugol’s iodide and graded again.Biopsy or pathological results were used as the diagnostic criteria.The sensitivity and specificity were indexed to evaluate the detection rate of the white light,NBI and iodide staining.Results Totally 86 lesions were found by the three methods,and 40 of them were histopathologically confirmed to be squamous cell carcinoma and precancerous lesions.Sensitivity and specificity of NBI in the diagnosis of early carcinoma and precancerous lesions were 0.85 and 0.89,respectively.Sensitivity and specificity rate of iodine staining in the diagnosis of early carcinoma and precancerous lesions were 0.80 and 0.91,respectively.NBI technology and iodine staining were superior to white light endoscopy in the diagnosis of early carcinoma and precancerous lesions(sensitivity and specificity were 0.65 and 0.50,respectively,P <0.05).The classification by NBI and iodine staining was consistent with pathological diagnosis(Kappa= 0.684,0.662).In the patients with esophageal cancer,6 repeated carcinomas were found(4 hypopharyngeal cancers and 2 gastric cancers).Conclusion NBI endoscopy is superior to ordinary white light endoscopy in the diagnosis of hypopharynx and early esophageal squamous carcinoma and precancerous lesions.NBI grade is consistent with pathological diagnosis classification.It may be possible to find hypopharyngeal carcinoma squamous(which is called multiplicity carcinoma)in patients with esophageal squamous carcinoma.更多还原