内镜下醋酸联合卢戈氏碘染色诊断早期食管癌

Endoscopic acetic acid-Lugol's iodine double staining for diagnosis of early esophageal cancer

目的:探讨内镜下醋酸联合卢戈氏碘双重染色对诊断早期食管癌的临床意义.方法:选择内镜检查中发现食管可疑病灶的患者先行卢戈氏碘染色,选择不着色或浅着色的随机分为两组:醋酸联合卢戈氏碘双重染色组(A组)及卢戈氏碘单一染色组(B组).双重染色组采取先喷洒醋酸,然后再喷洒卢戈氏碘液.两者重叠后出现黏膜褪色及着色不良为染色异常黏膜.在染色异常区活检,行组织病理学检查.结果:A组30例中有8例病理提示为食管癌,其中腺癌2例,鳞癌6例,术后病理结果显示均为早期食管癌,癌检出率26.67%.B组30例中食管鳞癌2例,检出率为6.67%,术后病理显示为早期食管癌.双重染色组食管癌检出率明显高于对照组,有显著性差异(P<0.05).A组30例中有6例病理显示为食管鳞癌,检出率为20.00%,B组30例中食管鳞癌2例,检出率6.67%,两者比较无明显差异(P>0.05).结论:初步证实内镜下醋酸联合卢戈氏碘染色可提高早期食管癌的检出率,其中两组鳞癌的检出率比较没有明显差别,但双重染色组检出2例腺癌,由此推测双重染色可能可以提高腺癌的检出率.

AIM：To evaluate the value of endoscopic acetic acid-Lugol＇s iodine double staining in the diagnosis of early esophagus cancer.METHODS：Patients with suspicious lesions first underwent Lugol＇s iodine staining,and the patients who showed no staining or poor staining were randomly divided into two groups：an acetic acid-Lugol＇s iodine double staining group（n = 30） and a Lugol＇s iodine staining group（n = 30）.The double staining group underwent spraying with acetic acid first and then with Lugol＇s iodine solution.The mucosa was considered abnormal when mucosal discoloration or poor coloration developed after double staining,and biopsy of abnormal mucosa for histopathological examination was performed.RESULTS：Eight（26.67%） patients of the double staining group were diagnosed with esophageal cancer by biopsy histopathological examination,containing 6 cases of esophageal squamous cell carcinoma and 2 cases of adenocarcinoma.Postoperative pathological diagnosis confirmed that all the 8 cases were early esophageal cancer.In the control group,2（6.67%） cases were found with esophageal squamous cell carcinoma by biopsy histopathological examination,and postoperative pathological diagnosis confirmed that both were early esophageal cancer.The detection rate of esophageal cancer in the double staining group was significantly higher than that in the Lugol＇ s iodine staining group（P 0.05）.The detection rate of esophageal squamous cell carcinoma showed no significant difference between the two groups（20.00% vs 6.67%,P 0.05）.CONCLUSION：Endoscopic acetic acid-Lugol＇ s iodine double staining can improve the detection rate of early esophageal cancer,especially adenocarcinoma.