接触性内镜在早期喉癌及其癌前病变诊断中的应用

Contact endoscope in the diagnosis of early carcinoma and precancerous lesions in the larynx

目的探索接触性内镜对早期喉癌及其癌前病变行微创病理学诊断的可行性。方法86例喉病变患者,在显微支撑喉镜下,于喉内病变处黏膜涂1%美蓝染色,将60×和150×接触性内镜置于黏膜表面,观察其病理变化,并与活检结果比较。结果接触性内镜的电子图像可较清晰显示表面黏膜不同病变细胞及核的大小、形状、排列、胞浆比、致密度和着色情况,有无中空细胞、核角蛋白,黏膜下微血管的排列情况。病理改变包括:任克式水肿(n=8),慢性喉炎(n=15),喉乳头状瘤(n=8),黏膜白斑(n=9),声带非典型性增生(n=18),恶性肿瘤(n=22),其他6例。结论接触性内镜作为一种新的微创性辅助检查方法,可用于喉癌及其癌前病变的诊断和动态随访。

Objective To investigate the applicability of contact endoscope in pathological diagnosis of early carcinoma and precancerous lesions in the largnx. Methods Eighty-six cases with laryngeal lesions were included in this study. They were all examined under self-retaining laryngoscope with general anesthesia, with 1% methylen blue smeared onto the diseaced laryngeal mucosa to make it stained and Storz contact endoscope placed onto the stained area to observe the living pathological pictures. Then, these pictures were compared with that of histopathology obtained fron the biopsy done following the contact endoscopy. Results The images collected from contact endoscopy could more clearly display the living pathological changes of surface lesions in laryngeal mucosa, such as cellular and nuclear size, shape and regularity, the ratio of nucleus to plasma, plasma density and its staining model, presence or absence of koilocytes and keratin, and the arrangement of micro-vessels in submucosa. Here, observed lesions included Reinke＇s edema（8/86）, chronic laryngitis（15/86）, laryngeal papilloma （8/86） ,keratosis（9/86）,dysplasia（18/86）, malignancies（22/86）and others（6/86）. Conclusion As a newer minimal invasive and auxiliary examining technique, contact endoscopy can be used to the diagnosis and dynamic monitor of early carcinoma and precancerous lesion in the larynx.