放大窄带成像内镜对不明性质胃溃疡的诊断价值

The value of ME-NBI in the diagnosis of unknown gastric ulcers

目的探讨放大窄带成像(narrow band imaging,NBI)内镜对不明性质胃溃疡的诊断价值。方法选取2013年4月-2014年4月不明性质的胃溃疡患者37例,通过放大NBI内镜检查观察病变处微腺管、微血管形态,结合内镜下重复活检及(或)内镜黏膜下剥离术、外科手术获取组织标本,送病理检查,根据病理结果分析放大NBI内镜检查对胃溃疡性质的诊断价值。结果 37例患者中临床诊断胃黏膜相关淋巴组织边缘带B细胞淋巴瘤(extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue,MALT淋巴瘤)1例,胃良性溃疡9例(梅毒性胃溃疡1例),胃癌22例(早期胃癌11例,进展期胃癌11例),癌前病变5例;放大NBI内镜检查对恶性胃溃疡诊断的阴性预测值、阳性预测值、灵敏度、特异度、准确度分别为80.0%、96.3%、92.86%、88.89%、91.89%,梅毒性胃溃疡及胃MALT淋巴瘤所致溃疡表现出特殊的微血管改变。结论放大NBI内镜检查是帮助诊断不明性质胃溃疡的有效手段。

Objective To investigate the value of magnifying endoscopy and narrow band imaging（ ME-NBI） in the diagnosis of unknown gastric ulcers. Methods Thirty-seven cases of unknown gastric ulcers from Apr. 2013 to Apr.2014 were enrolled in this study. Micro duct lesions and micro vascular morphology were observed by ME-NBI,and tissue samples were collected by repeated endoscopic biopsy,endoscopic submucosal dissection or surgery were examined by pathological examination; then the value of ME-NBI on the diagnosis of uncertain gastric ulcers was analyzed by comparing the observations of ME-NBI with pathological results. Results One case of extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue（ MALT lymphoma）,9 cases of benign gastric ulcer（ 1 case of syphilitic ulcer）,22 cases of gastric cancer（ 11 cases of early gastric cancer and 11 cases of advanced gastric cancer）,5 cases of precancerous lesions were finally diagnosed; the negative predictive value,positive predictive value,sensitivity,specificity and accuracy of ME-NBI in the diagnosis of gastric ulcers was 80. 0%,96. 3%,92. 86%,88. 89%,91. 89%,respectively. Besides,syphilitic ulcer and gastric ulcer induced by MALT lymphoma showed micro vascular change specially. Conclusion ME-NBI plays an effective role in the diagnosis of unknown gastric ulcer.