内镜窄带成像技术在胃癌及癌前病变诊断中的应用

Narrow band imaging endoscopy for diagnosis of malignant and premalignant gastric lesions

目的探讨内镜窄带成像技术（NBI）对胃癌及癌前病变的诊断价值。方法217例患者依次在普通内镜、NBI、0．2％靛胭脂染色及内镜放大（×80）模式下观察病变轮廓、胃小凹及微血管形态，评价各检查方法图像的清晰度，并结合病理学检查进行分析。结果217例患者中，非萎缩性胃炎85例，萎缩性胃炎38例，轻度异型增生19例，中度异型增生9例，重度异型增生4例，早期胃癌5例，进展期胃癌20例，伴有肠化生者91例。NBI对病变轮廓的显示明显优于普通内镜和靛胭脂染色（P值均=0．000）。经内镜放大后，NBI对胃微血管形态的显示亦优于普通内镜和靛胭脂染色（P值均=0．000）。NBI模式下萎缩性胃炎胃小凹主要表现为Ⅲ、Ⅳ、Ⅴ1型，肠化生主要表现为Ⅲ、Ⅳ、Ⅴ1、Ⅴ2型，异型增生主要表现为Ⅴ1型及Ⅳ型，胃癌主要表现为Ⅵ型。结论NBI电子染色结合放大技术有助于提高胃癌及异型增生的活检准确率和早期胃癌检出率。

Objective To evaluate the clinical value of narrow band imaging（NBI） for diagnosis of malignant and premalignant gastric lesions. Methods The gastric lesions, pits and microvascularity were observed using conventional endoscopy followed by narrow band imaging （NBI） and chromoendoscopy （0.2 % indigo carmine） as well as magnifying endoscopy（ × 80） in 217 patients. The quality of images obtained by different endoscopies was evaluated and compared to pathologic interpretations. Results Of 217 patients, non-atrophic gastritis was found in 85 cases, chronic atrophic gastritis in 38 cases, mild dysplasia in 19 cases, moderate dysplasia in 9 cases, severe dysplasia in 4 cases, early gastric cancer in 5 cases, advanced gastric cancer in 20 cases and intestinal metaplasia in 9i cases. The NBI endoscopy was superior to conventional endoscopy and chromoendoscopy in finding gastric lesions （P = 0. 000）. The gastric microvascularity was more clearly seen on images obtained by NBI combined with magnifying endoscopy in comparison with conventional endoscopy and chromoendoscopy （P= 0. 000）. There were six patterns in description of gastric pits with NBI endoscopy. Type Ⅲ , Ⅳ or Ⅴ1 was usually found in chronic atrophic gastritis, type Ⅲ , Ⅳ, Ⅴ1 or Ⅴ2 in intestinal metaplasia, type Ⅴ1 or Ⅳ in dysplasia and type Ⅵ in suspected malignant lesion. Conclusions NBI with magnifying endoscopy is helpful in improving the biopsy accuracy of malignant and dysplastie lesions and in detecting early gastric cancer.