放大内镜联合智能电子分光技术诊断早期胃癌的临床研究

Magnifying endoscopy combined with FICE imaging in the diagnosis of early gastric cancer

目的通过分析放大胃镜联合富士能智能电子分光技术（FICE）诊断早期胃癌的准确度，评价其临床应用价值。方法2009年4月至2011年3月在常规内镜检查时发现可疑的微小凹陷病变（SDL），则分别用放大胃镜和放大胃镜联合FICE进行观察，参照国外文献，根据病变处腺管开口形态、微血管形态及病变处与周围黏膜的界限三方面指标，初步制定早期胃癌内镜诊断标准，并根据此标准对病变做出内镜诊断。结果74处可疑SDL中，病理组织学证实癌性病变17例，非癌性病变56例。放大胃镜的敏感度、特异度、准确度分别为41．18％、94．74％和82．43％。放大胃镜联合FICE的敏感度、特异度、准确度分别为86．67％、96．49％和91．89％。放大胃镜联合FICE诊断的敏感度明显高于放大胃镜（P〈0．05）。结论放大胃镜联合FICE可以更清晰的观察病变的腺管开口、微血管及病变与周围组织的界线等微细结构。我们制定的内镜诊断标准，可以更全面的概括了早期胃癌的黏膜微细形态特征，提高内镜诊断的准确度。

Objective To evaluate magnifying endoscopy combined with flexible spectral imaging color enhancement（FICE） for diagnosis of early gastric cancer. Methods The suspicious small depressive lesions（SDL） was further studied with magnifying endoscopy or magnifying endoscopy combined with FICE from April 2009 to March 2011 in our hospital. The endoscopic diagnostic criteria of early gastric cancer was made according to the structure of the pit, the microvascular and the demarcation line. Results In 74 SDL, 17 were pathologically diagnosed as cancer, and 56 were noncancer. The sensitivity, specificity and accuracy of magnifying endoscopy were 41.18%, 94. 74% and 82.43%, respectively, which were 86. 67%, 96.49% and 91.89%, respectively for magnifying endoscopy combined with FICE. The diagnostic sensitivity of magnifying endoscopy combined with FICE was significantly higher than that of magnifying endoscopy（ P 〈 0. 05）. Conclusion Magnifying endoscopy combined with FICE can reveal the structure of the pit, microvascular and demarcation line more clearly. The endoscopic diagnostic criteria is a more comprehensive description of the mucosal micro-morphological features of early gastric cancer.