窄带成像放大内镜对早期食管癌及癌前病变的诊断价值

Diagnostic Value of Narrow-band Imaging System with Magnifying Endoscopy in Early Esophageal Carcinoma and Precancerous Lesions

目的:研究食管黏膜微血管改变与组织学的关系,以探讨窄带成像放大内镜(NBI-ME)对早期食管癌及癌前病变的诊断价值。方法:168例常规内镜下食管黏膜病变患者用窄带成像技术(NBI)、卢戈氏碘染色法观察其上皮乳头内毛细血管袢(IPCL)的形态学改变,并活检组织做病理学分析;30例正常者做对照组。结果:NBI和碘染色内镜显示食管病变程度及范围明显优于常规内镜,但碘染色内镜存在不良反应(15.65%);正常对照、食管炎、低级别瘤变、高级别瘤变及食管癌IPCL主要形态分类分别为Ⅰ型(100%)、Ⅱ型(84.45%)、Ⅲ型(52.00%)、Ⅲ型(69.23%)、Ⅳ型(64.29%)。结论:NBI内镜可以替代碘染色内镜;亦可根据食管黏膜IPCL形态判定组织学类型,提高了早期食管癌及癌前病变的发现率。

Objective To explore the diagnostic value of narrow-band imaging （NBI） system with magnifying endoscopy in early squamous esophageal cancer and precancerous lesions on basis of the relationship between microvascular changes of esophageal mucosa and histology. Methods The morphology change of intraepithelial papillary capillary loop was observed with narrow-band imaging and Lugol＇s iodine staining in 168 patients with esophageal mucosa, and pathological biopsy were performed ,thirty healthy volunteers were enrolled as control. Results NBI and Lugol＇s iodine staining endoscope were superior to conventional endoscope on the degree and extent of esophageal lesions, but there were 15.65 % side effects accurance in iodine staining endoscope;the main morphons classification of normal control, esophagitis, low grade neoplastic lesion, high grade neoplastic lesion and IPCLwere type Ⅰ （ 100% ） ,type Ⅱ （84.45%） ,type Ⅲ （52.00%） ,type Ⅲ （69.23%）, type Ⅳ （64.29%）, respectively. Conclusion NBI endoscopy could replace iodine staining endoscopy;the histological type could be classified with ICPL of esophageal mucosa, NBI magnifying endoscopy can improve the diagnostic rate of early squaraous esophageal cancer and precancerous lesions.