窄带成像放大内镜鉴别大肠肿瘤性与非肿瘤性病变的价值

Narrow-band imaging system with magnifying endoscopy in differentiating colorectai neoplasms from non-neoplasms

目的 探讨窄带成像放大内镜（NBI—ME）鉴别大肠肿瘤性与非肿瘤性病变表面网状微血管结构改变的临床价值。方法选择常规内镜检出大肠肿瘤性、非肿瘤性病变144处（102例），记录NBI—ME观察病变表面微血管结构（CP）形态和染色放大内镜观察病变黏膜表面腺管开口（pit）形态。分析pit周围CP形态变化，比较两者形态间的关系。所有病变经内镜或手术治疗后行组织病理学检查。结果常规内镜鉴别病变是否为肿瘤性的准确率75．7％、敏感性85．1％、特异性40．0％，明显低于NBI—ME和染色放大内镜（P〈0．005），NBI—ME和染色放大内镜间则未见差异。CP分型与pit分型对照，CP—Ⅰ型、Ⅱ型、Ⅳ型、Ⅵa型分别与pitⅠ型、Ⅱ型、Ⅳ型、Ⅴ1型间一致性达100％。144处病变中，内镜治疗129处，手术治疗15处。组织病理学检查：非肿瘤性30处（增生性息肉17处、炎症性息肉13处）；肿瘤性114处（腺瘤95处、腺癌19处）。结论初步显示NBI—ME和染色放大内镜之间具有正相关性，两种检查方法互补可作为当前鉴别大肠病变是否为肿瘤性的重要手段。

Objective To observe the meshed capillary pattern （CP） on the surface of colorectal lesions by narrow-band imaging system with magnifying endoscopy （NBI-ME）, and to distinguish neoplasm from non-neoplasm by the change of capillary patterns. Methods A total of 144 eolorectal lesions in 102 patients detected by conventional eolonoscopy were evaluated by NBI-ME to observe the CP on surface, and by staining magnifying colonoscopy to observe the pit pattern. Results All lesions were resected endoscopically （129/144） or by surgery （15/144）, and the pathological evaluation diagnosed 30 cases of non-neoplasm （including 20 cases of hyperproliferative polyps and 10 of inflammatory polyps） and 114 cases of neoplasm （including 95 cases of adenoma and 19 cases of adenocarcinoma）. The diagnostic accuracy rate, sensitivity and specificity of conventional colonoscopy were 75.7% , 85. 1% and 40. 0% , respectively, which were significantly lower than those of NBI-ME and staining magnifying colonoscopy （ P 〈 0. 005 ） , while there was no significant difference between NBI-ME and staining magnifying colonoscopy. The CP of type Ⅰ , Ⅱ , Ⅳand Ⅵa were totally correspondent with pit pattern of type Ⅰ , Ⅱ , ⅣandⅤ1 Conclusion NBI-ME findings of colorectal lesions correlated with those of staining magnifying colonoscopy. These two techniques are both helpful in differentiating colorectal neoplasms from non-neoplasms.