窄带成像技术对大肠增生性病变的诊断价值研究

Narrow-band imaging endoscopy in differential diagnosis of colorectal proliferative lesions

目的探讨窄带光谱成像技术（NBI）对大肠增生性病变的诊断价值。方法在白光及NBI模式下分别对大肠可疑病灶进行观察、诊断，以活检病理学检查结果作为金标准，对比NBI与传统肠镜诊断大肠炎性增生、腺瘤、早癌及进展期肿瘤的敏感性及特异性。采用NBI模式结合放大内镜观察各种大肠增生性病灶的腺管开口分型及病灶表面微血管形态并进行评分，总结NBI下大肠各种增生性病灶的内镜下特点。结果（1）传统肠镜及NBI技术检查280例患者共发现368处病灶，NBI诊断大肠炎性增生、腺瘤及早癌的敏感性及特异性明显高于传统肠镜。（2）NBI下大肠炎性增生的腺管开口多为Ⅰ、Ⅱ型，腺瘤多为Ⅱ、Ⅲ型（共占94．2％），早癌的腺管开口可为Ⅲ（18．8％）、Ⅳ（56．3％）和Ⅴ型（25．0％），进展期肿瘤多为Ⅴ型开口（94．0％）。（3）NBI下大肠炎性增生、腺瘤、早癌及进展期恶性肿瘤的微血管形态学平均评分分别为1．35±0．72、3．86±1．07、6．52±2．59和11．42±3．59，评分在6．5分以上病灶高度提示为恶性病灶。结论NBI在鉴别诊断大肠增生性病灶的敏感性及特异性明显高于传统肠镜，NBI结合放大内镜对病灶腺管开口分型及微血管形态的观察能帮助预测病灶的病理性质。

Objective To evaluate the narrow-band imaging （NBI） in differential diagnosis of colorectal proliferative lesions. Methods Suspected lesions in colon were examined with white light and NBI colonoscopy, respectively. The ensitivity and specificity in diagnosing colorectal inflammatory hyperplasia, adenoma, early cancer and advanced cancer were compared between NBI and conventional colonoscopy with reference to pathology as gold standard. The pit patterns and the surface microvessels of the lesions were also determined and scored with NBI combined with magnifying endoscopy, and were compared with pathological diagnosis. Results （ 1 ） A total of 368 lesions were detected in 280 patients with conventional colonoscopy and NBI. The sensitivity and specificity of NBI in differential diagnosis of colorectal lesions were superior to those of conventional colonoscopy. （2） The pit patterns of colorectal inflammatory hyperplasia were mainly type Ⅰ and Ⅱ , while in adenomas were mainly type Ⅱ and Ⅲ （94. 2% ）. The pit patterns of early cancer were type Ⅲ （ 18.8% ）, Ⅳ （56. 3% ） and V （25.0%）, and those of advanced cancer were mainly typeⅤ （94. 0% ）. （ 3 ） The average scores of surface microvessels of colorectal inflammatory hyperplasia, adenoma, early cancer and advanced cancer were 1.35 ± 0. 72, 3.86 ± 1.07, 6. 52 ± 2.59 and 11.42 ± 3.59, respectively. Scores over 6. 5 was a strong indicator of malignant lesions. Conclusion NBI is superior to conventional eolonoseopy in differential diagnosis of colorectal lesions. Observing pit patterns and microves-sels of the lesion with combination of NBI and magnifying endoscopy is helpful in diagnosis.