染色结肠镜和染色放大结肠镜在结直肠隆起性黏膜病变中临床应用价值的研究

Role of magnifying chromoendoscopy and chromoendoscopy in detection and diagnosis of colorectal protrude lesions

目的探讨普通结肠镜、染色结肠镜、染色放大结肠镜在结直肠隆起性黏膜病变中临床应用价值。方法对30例结肠镜检查发现黏膜隆起性病变的病人,先作普通结肠镜诊断,再作染色结肠镜诊断,最后用放大结肠镜作出诊断。所有病变作病理学检查。将普通结肠镜、染色结肠镜、染色放大结肠镜的诊断结果与病理学诊断结果进行比较分析。结果共发现64个隆起性黏膜病变,普通结肠镜诊断为炎性息肉、管状腺瘤、绒毛状腺瘤、结直肠癌与病理诊断的符合率分别为68.8%、76.9%、66.7%和80%,总病理符合率为73.4%;染色结肠镜分别为86.7%、87.5%、85.7%和90.9%,总病理符合率为87.5%;染色放大结肠镜分别为93.3%、91.7%、92.9%和90.9%,总病理符合率为92.2%。结论普通结肠镜不能有效鉴别结直肠隆起性黏膜瘤性与非瘤性的改变,需要依赖病理组织学判断性质。染色结肠镜与染色放大结肠镜均能有效提高对结直肠隆起性黏膜瘤性与非瘤性病变的鉴别能力,具有较高的临床应用价值。染色结肠镜应列为常规检查以提高早期结肠肿瘤的检出率。

[Objective] To study the clinical value of magnifying chromoendoscopy and chromoendoscopy in detection and diagnosis of colorectal protrude lesions. [Methods] A total of 64 colorectal protrude lesions in 30 patients were included from March 2004 to March 2005. All lesions detected on colonoscopy were first diagnosed on the conventional view. Then 0.4% indigo camine solution was spayed on the lesion mucosa surface at chromoendoscopy and finally at magnifying chromoendoscopy. The diagnosis at each step were recorded consecutively. All lesions were finally polypectomy or biopsy for histological diagnos. All examinations were performed by a single endoscopist. [Results] The diagnostic accuracy of conventional colonoscopy, chromoendoscopy and magnifying chromoendoscopy compared with histological diagnosis of inflammatory polyps, tubular adenomas, villous adenomas and colorectal cancer was 68.8%, 76.9%, 66.7% and 80% respectively and 86.7%, 87.5%, 85.7% and 90.9% respectively and 93.3%, 91.7%, 92.9% and 90.9% respectively. The overall diagnostic accuracy of three procedures was 73.4%, 87.5% and 92.2% respectively. [Conclusions] Magnifying chromoendoscopy and chmmoendoscopy with indigo carmine dye is a reliable and useful method for differentiating neoplastic from non-neoplastic lesions of the colorectum. Chromoendoscopy could be used as a routine procedure in order to enhance the early diagnosis of coloreetal cancers. However, this technique is not a substitute for histology in current state.