窄带成像内镜对胃良恶性溃疡的诊断价值研究

Value of narrow band imaging endoscopy in diagnosis of benign and malignant gastric ulcers

目的观察研究窄带成像技术(NBI)对内镜下胃良、恶性溃疡的鉴别诊断价值。方法对58例常规胃镜检查发现胃溃疡的患者依次采用常规模式、NBI模式及靛胭脂染色放大方法进行观察,重点观察溃疡周边黏膜的胃小凹及微血管,评价各检查方法图像的清晰度,于改变最显著部位活检行病理学检查。结果58例胃溃疡患者中,良性溃疡37例,恶性溃疡21例。在观察溃疡轮廓方面,NBI与染色内镜或普通内镜之间差异有显著性,NBI最清晰;对于溃疡周边黏膜胃小凹的形态观察,NBI或染色内镜均优于普通内镜;在对溃疡周边黏膜微血管的观察中,NBI具有绝对优势。NBI模式下,胃小凹形态分为6种类型,恶性溃疡周边黏膜胃小凹多为Ⅵ型,此型与胃癌病理学诊断符合率达94.8%,敏感性90.5%、特异性97.3%。NBI放大内镜下86.5%(32/37)的良性溃疡周边黏膜微血管走形规则,85.7%(18/21)的恶性胃溃疡周边黏膜可观察到不规则走形的微血管。结论NBI,电子染色,操作简便,对胃溃疡轮廓显示清晰,放大后更可清晰观察到溃疡周边黏膜的胃小凹及微血管形态,有助于提高胃癌的靶向活检准确率,对提高早期胃癌的检出率具有潜在的重要意义。

[Objectives] To probe into the value of narrow band imaging endoscopy in diagnosis of benign and malignant gastric ulcers. [Methods] Totally 58 endoscopic gastric ulcer patients were enrolled. Routine endoscopy was followed by narrow band imaging （NBI）, and then by chromoendoscopy （indigo carmine） combined magnifying endoscopy sequentially. The gastric pits and microvasculature were carefully observed on the mucosa around ulcer. According to the NBI images, the biopsy samples were taken in suspicious area to identify malignant lesion. At the same time, the images with different endoscopic methods were saved. Subsequently, the quality of the images was evaluated by another senior endoseopist. [Results] In silhouette of gastric ulcer, NBI is the clearest in the above three endoscopic methods. Both mueosal pit and epithelium capillary were shown much clearer by NBI and chromoendoseopy than by routine endoscopy. Six patterns of gastric pits were summarized by NBI. Of 58 gastric ulcer patients, 21 cases of gastric cancer were diagnosed according to histopathological examination. Type Ⅵ gastric pit was mostly seen around malignant lesion. The accuracy of cancer on target biopsies according to type Ⅵ mucosal pit was 94.8%, the sensitivity and specificity were 90.5% and 97.3%, respectively. Regular microvasculature appeared in 86.5% of benign gastric ulcer, while irregular microvaseular pattern shaped in 85.7% of malignant gastric ulcer. [Conclusions] By narrow band imaging system with magnifying endoscopy, the mueosal mierostructures as gastric pits and mierovasculature around gastric ulcer can be shown very clear. That is helpful for improving the accuracy of endoscopic target biopsies for malignant lesions and finding early gastric cancer.