内镜醋酸染色结合窄带成像对大肠肿瘤性和非肿瘤性病变的鉴别诊断价值

Acetic acid spray combined with narrow band imaging in differential diagnosis of colorectal neoplastic and non-neoplastic lesions

目的评价醋酸染色结合普通窄带成像（NBI）内镜观察对大肠新生性病变的病理组织学的预测能力。方法105例接受结肠镜检查的患者，诊断大肠新生性病变148个，分别用普通白光、单一NBI及醋酸染色结合NBI的方法观察，根据腺管形态分型、微血管形态分型、黏膜白化时间预测病变为肿瘤性或非肿瘤性，并与病理结果对照判断其敏感度、特异度和准确率。结果醋酸染色结合NBI对大肠肿瘤性病变诊断的总符合率为91．2％（135／148），明显高于普通白光内镜的79．1％（117／148）（x^2=8．649，P=0．003），高于单一NBI的86．5％（128／148），但醋酸染色结合NBI与单一NBI比较差异无统计学意义（x^2=1．671，P=0．196）。醋酸染色结合NBI的腺管形态分型、微血管形态分型、黏膜白化时间鉴别肿瘤性和非肿瘤性病变的敏感度分别是90．6％、94．1％、88．2％，特异度分别是90．5％、85．7％、92．1％，准确率分别是90．5％、90．5％、89．9％。结论醋酸染色结合NBI对鉴别大肠肿瘤性或非肿瘤性病变具有可靠的诊断价值，可以初步判断病变的病理类型，对治疗方法的选择及疗效和预后的判断有指导意义。

Objective To analyze the characteristics of morphology, microvascular and mucosa whitening time of colorectal lesions by acetic acid spray combined with narrow-band imaging （NBI） , and to evaluate its predictive ability in differentiation of histology of colorectal lesions. Methods A total of 148 colorectal polypoid lesions in 105 patients detected by routine colonoscopy were observed by white light, NBI, and acetic acid spray combined with NBI, respectively. The lesions were differentiated into neoplastic or non-neoplastic according to its pit pattern, capillary type and mucosa whitening time, and the sensitivity, specificity and accuracy of different methods were evaluated according to pathological findings. Results The overall accuracy of acetic acid spray combined with NBI in diagnosis of colorectal neoplastic lesions was 91.2% , significantly higher than that of white light （ 79. 1% , x^2 = 8. 649, P = 0. 003 ）, while no significant difference was found between acetic acid spray combined with NBI and NBI only （86. 5% , x^2 = 1. 671, P = 0. 196 ）. The sensitivities of pit pattern, mierovaseular type and mucosa whitening time in diagnosis of eoloreetal neoplastic lesions were 90. 6% , 94. 1% and 88.2% , the specifieities were 90. 5% , 85.7% , 92. 1%, and the accuracies were 90. 5%, 90. 5% and 89.9%, respectively. Conclusion Acetic acid spray combined with NBI in the differentiation of colorectal neoplastic or non-neoplastic lesion has a reliable diagnostic value in differentiating neoplastic coloreetal lesions.