NBI-ME内镜技术在结直肠早期肿瘤诊治中的价值

The value of Narrow Band Imaging combined with Magnifying Endoscopy in the diagnosis and treatment of early colorectal tumors

目的通过窄带成像放大内镜技术(NBI-ME)对结直肠病变进行观察,研究NBI-ME内镜技术对发现结直肠新生性病变的优势,以及对结直肠肿瘤性病变判断的精准度。方法 680例患者进行了完整普通肠镜、NBI-ME、色素内镜检查。对新生性病变分别用普通光镜、NBI-ME模式及色素放大方法观察病变表面结构,记录微血管形态(MP)和腺管开口分型(pit),对病变性质的判断结果与病理诊断比较。结果 NBI-ME在385例患者发现新生性病变513个,而普通光镜只检出其中的74.1%(380/513),有显著统计学差异(P<0.01)。色素内镜能检出86.0%(441/513),也有显著统计学差异(P<0.05)。普通光镜漏检主要为微小病变及平坦型病变。NBI-ME对判断病变肿瘤性或非肿瘤性准确率为94.2%,敏感性90.2%,特异性95.3%,显著高于普通光镜和色素内镜(P<0.001)。结论 NBI-ME内镜技术有利于发现微小病变和平坦型病变,能清晰观察病变表面pit形态结构、微血管形态,对判断病变肿瘤性或非肿瘤的准确率明显比普通内镜和色素内镜高,检查操作时转换模式方便,NBI-ME将成为发现结直肠新生性病变和鉴别是否肿瘤性的更有效的内镜检查方法。

Objective This research aimed to study the superiority of detection colorectal neoplasm by Narrow Band Imaging combined with Magnifying Endoscopy（ NBI - ME ）, and to compare the diagnostic accuracy of NBI - ME in differentiating neoplastic from non - neoplastic colorectal lesions with chromoendoscopy and conventional light colonoseopy. Methods 680 patients were examined by NBI - ME and chromoendoscopy, after they were observed with conventional light colonoscopy. The morphous on the surface of colorectal lesions were observed, while the microvascular architecture （MP）and pit patterns （pit） on the surface of neogenesis lesions were recorded, the neogenesis lesions were reseeted or biopsy for histopathologieal analysis. To compare with histopathology diagnosis , the diagnostic accuracy, sensitivity, specificity of neoplasia lesions of each endoscopic modality were assessed. Results 513 neogenesis lesions were found in 385 patients by NBI - ME, it was significantly more than two orther methods, while 86.0% （441/513） neogenesis lesions were detected by chromoendoscopy （P 〈 0.05 ） , Only 74. 1% （380/513 ） neogenesis lesions were discovered under the conventional light colonoseopy （P 〈 0. 01 ） , be- cause some minimal lesion and fiat lesions were missed. The diagnostic neoplasm accuracy, sensitivity, specificity of NBI - ME were 94. 2 %, 90. 2 % and 95.3 %, respectively, it was significantly higher than conventional colonoseopy and ehromoendoscopy（P 〈 0. 001 ）. Conclusion NBI - ME was in favour of discover minimal and fiat colorectal neogenesis lesions, it can distinguish neoplastic from non - neoplastic coloreetal lesions , and the diagnostic accuracy of NBI - ME was higher than the conventional colonoseopy and chromoendoscopy. It indicated that NBI - ME was an new clinical usefulness technology for detection and prediction of colorectal tumors.