内镜窄带成像技术在结肠肿瘤诊断中的价值

Narrow-Band Imaging in diagnosis of colorectal neoplasm

目的 将内镜窄带成像技术（NBI）、色素内镜检查结果与病理学检查结果进行对比，探讨NBI在结肠肿瘤诊断中的价值。方法78例患者96个结肠病变进行NBI放大观察并与染色放大内镜观察和最终病理结果进行比较。结果普通肠镜发现息肉的敏感性为78．7％，切换NBI后，能清楚显示息肉性病变的形态和边界，发现息肉的敏感性99％。放大NBI肠镜对于Ⅱ型，Ⅲ1型，Ⅳ型，ⅤN型息肉腺管开口的图像与色素内镜图像有较好的相似性，NBI对于腺管开口的识别能力明显优于普通结肠镜，但是次于色素内镜。NBI对息肉表面血管形态进行分类对判断结肠是否有肿瘤的能力，其敏感性为100％，特异性为87．8％，同样明显优于普通结肠镜，而次于色素内镜。结论NBI肠镜及色素内镜均能提高发现结肠息肉的特异性、敏感性。色素内镜能清晰显示病变表面结构和腺管开口，使内镜下对于肿瘤与非肿瘤的鉴别诊断接近病理诊断。NBI放大肠镜能清晰显示息肉表面的毛细血管形态，较好地区分肿瘤与非肿瘤。NBI内镜切换简单快捷，便于全结肠观察，利于发现早期结肠肿瘤。

Objective To evaluate the efficacy of narrow-band imaging （NBI） in diagnosis of colorectal neoplasm. Methods A total of 96 eolorectal neoplasm from 78 patients were observed under NBI, and the findings were compared with those from magnifying chromo-endoscopy and pathologic examinations. Resuits The sensitivity of conventional colonoscopy in diagnosis of polyps was 78. 7% , which was increased to 99% （ P 〈 0. 05 ） under NBI, with the clear identification of the shape and boundary of the lesions. Magnifying NBI colonoscopy provided images of pit patterns similar to those from chromo-endoscopy in diagnosis of type Ⅱ , ⅢL, Ⅳ andⅤN, which showed better recognition than conventional colonoscopy, but less sensitivity than chromo-endoscopy. Superficial vascular morphologic features could be better classified with NBI, with sensitivity of 100% and specificity at 87. 8%, which was superior to conventional colonoscopy but inferior to chromo-endoscopy. Conclusion Both chromo-endoscopy and NBI colonoscopy have better sensitivity and specificity in detection of colon polyps, while chromo-endoscopy reveals clear superficial structure of lesion and pit pattern, and NBI demenstrates capillary morphology, which can distinguish neoplasm from nonneoplasm colorectal lesions. NBI, easy and convenient to switch, is an effective technique to make early diagnosis of colorectal neoplasm.