甲苯胺蓝色素胃镜诊断胃癌及其癌前病变的价值

The Role of Chromoendoscopy with Toluidine Blue for Diagnosis of Gastric Cancer and Precancerous Change.

目的探讨甲苯胺蓝色素胃镜检查在胃癌及其癌前病变诊断中的作用。方法本试验中病例572例,按照完全随机化原则分为试验组和对照组,试验组288例,喷洒0.1%甲苯胺蓝溶液行色素胃镜检查;对照组284例,行普通胃镜检查。所有病例均活检并送病理检查,其中试验组若出现异色区则在异色区活检,其余均在可疑病变处活检。结果试验组胃癌检出率9.72%,对照组胃癌检出率5.28%,前者高于后者,二者差异显著(P<0.05);甲苯胺蓝色素胃镜检查对胃癌的异色反应阳性率为75.00%,对胃黏膜肠上皮化生的异色反应阳性率为72.22%,对不典型增生异色反应阳性率为54.16%,三者之间无差异,提示甲苯胺蓝色素胃镜检查显示胃黏膜癌前病变具有比较高的敏感性。结论甲苯胺蓝色素胃镜检查能提高胃癌检出率,对各种不同病理组织学类型的胃癌均能良好显示;甲苯胺蓝色素胃镜检查对显示胃癌的癌前病变具有一定的敏感性,应用该方法对胃癌癌前病变患者进行随访可提高早期胃癌的检出率。甲苯胺蓝色素胃镜检查值得临床推广应用。

Objective To study the role of chromoendoscopy with toluidine blue to diagnose gastric cancer and precancerous change. Methods 572 cases were randomized into two groups. 288 cases in testing group took gastroscopy with 0. 1% toluidine blue sprinkles, while ordinary gastroscopy was applied in 284 cases of control group. We took biopsy in all of those cases for pathology examination. The biopsy was taken from heterochrome area if heterochrome area appeared in testing group, otherwise from suspected affection. Results Detection rate of gastric cancer of test groups （9.72%） was higher than that of control groups （5.28%）. Both of the methods were significantly different（ P 〈 0. 05）. The heterochrome rate in chromoendoscopy with toluidine blue is 75% in gastric cancer, 72. 22% in intestinal metaplasia and 54.16% in atypical hyperplasia. There was no significant difference in heterochrome rate among those groups, which suggested that toluidine blue gastroscopy showed higher sensibility in detecting precancerous change of gastric mucosa. Conclusion Chromoendoscopy with toluidine blue con raise detection rate of gastric cancer. Gastric cancer of all kinds of histopathology type can get good demonstration. This method displayed higher sensibility in detecting precancerosis of gastric cancer compared with normal method. Therefore chromoendoscopy with toluidine blue can be applied in follow - up of patients with precancerosis of gastric cancer to enhance the detection rate of gastric cancer in early stage. This kind of chromoendoscopy deserves wide application in clinic.