卢戈液-美蓝双重染色联合超声小探头诊断食管早期癌及癌前病变的临床研究

Double staining of Lugol's solution and methylene blue combined with miniprobe sonography to diagnose early esophageal cancer and precancerous lesions:report of 217 cases

目的探讨内镜下卢戈液-美蓝双重染色联合超声小探头诊断食管早期癌及癌前病变的临床价值。方法对食管可疑病变先后用3%卢戈液和0.5%美蓝喷洒病变黏膜,观察病变染色程度及范围。对卢戈液不染或淡染-美蓝染色病变行活组织病理学检查,并用超声小探头探查病变浸润深度。结果卢戈液不染或淡染-美蓝染色217例,病理为食管早期癌89例,不典型增生128例(轻度34例,中度68例,重度26例),卢戈液不染或淡染-美蓝染色诊断食管早期癌及不典型增生准确率为100%。超声小探头显示116例浸润至黏膜上皮层,37例浸润至黏膜肌层,30例浸润至黏膜下层,6例出现淋巴结转移。术后病理:上皮内癌18例,黏膜肌层癌32例,黏膜下癌39例,与其对照,超声小探头鉴别黏膜内癌和黏膜下癌的准确性为89.9%(80/89)。结论卢戈液-美蓝双重染色联合超声小探头有助于提高食管早期癌及癌前病变的检出率和诊断率,对合理选择治疗方法有指导意义。

Objective To explore the clinical value of double staining Lugol＇ s solution and methylene blue combined with miniprobe sonography in diagnosis of early esophageal cancer and precancerous lesions. Methods During gastroscopic examination, 3% Lugol＇ s solution was sprayed on the doubtful esophageal lesions first, followed by 0.5% methylene blue spraying on those unstained or weakly stained. The degree and range of the lesions were observed. Biopsies were performed in the lesions stained by methylene blue but not or weakly stained by Lugol＇ s solution. The lesion＇ s infiltrative depth was assessed by miniprobe sonography （ MPS ）. Results Among 217 cases stained by methylene blue but not or weakly stained by Lugol＇ s solution, 89 cases were diagnosed pathologically as early esophageal cancer, and the left 128 cases showed dysplasia at different degrees ineluding mild dysplasia in 34 eases, moderate in 68 cases and severe in 26 cases. The diagnostic accuracy rate in early esophageal cancer and dysplasia by our double staining was 100%. MPS showed that 116 cases had epithelium mueosae infiltration, 37 cases muscularis mucosae infiltration, 30 cases had submueosa was infiltration, and 6 eases had the lymph node metastasis. Intraepithelial carcinoma was verified pathologically in 18 cases, muscularis mucosae carcinoma in 32 cases, and submueosal carcinoma in 39 cases. The accuracy rate of MPS in differentiaring intramueosal carcinoma from submucosal carcinoma was 89.9%. Conclusion The double staining combined with miniprobe sonography is helpful in the detection and diagnosis of early cancer and precancerous lesions of esophagus, and exerts guidable significance in the selection of reasonable treatment method.