电子喉镜下喉部碘溶液染色诊断早期喉癌的临床应用研究

Clinical application of iodine solution staining in the diagnosis of early laryngeal cancer with electronic endoscope

目的:初步探讨电子喉镜下喉部碘溶液染色的可行性及对早期喉癌诊断的临床应用价值。方法:将符合纳入标准的90例早期喉癌患者随机分为a、b、c三组。所有患者均采用电子喉镜及窄带成像技术(NBI)模式检查。a组采用0.5%Lugol液碘染色(0.5%Lugol液组),b组采用1.0%Lugol液碘染色(1.0%Lugol液组),c组采用1.5%Lugol液碘染色(1.5%Lugol液组)。分别记录每组中每例患者3种检查方法的阳性病灶位置及范围,对电子喉镜阳性、NBI阳性及碘染色阳性病灶均分别取活检,如果阳性病灶位置重复,该部位只取1次活检。以病理结果作为诊断金标准,将其他检查结果与之作为对照。每组分别观察碘在喉部着色情况,随访所有患者24h内是否存在呼吸困难、严重的咽喉疼痛等不适症状,并于检查后24h再次进行电子喉镜检查。结果:所有患者在碘染色24h后行电子喉镜检查均无明显的咽喉黏膜及声门下方气管黏膜红肿等炎症反应,均表示可以接受,无排斥抵触心理。以1.0%及以下浓度的Lugol液进行碘染色,对早期喉癌诊断的敏感性高于电子喉镜,两者在早期喉癌诊断中差异无统计学意义(P>0.05)。1.5%Lugol溶液碘染色与电子喉镜比较,两者差异有统计学意义(P<0.05);1.5%Lugol溶液碘染色与NBI检查比较,两者差异无统计学意义(P>0.05)。结论:1.5%及以下浓度的Lugol碘溶液在电子喉镜下喉部染色安全可行。1.5%Lugol碘溶液在电子喉镜下的喉部染色对早期喉癌的诊断明显优于电子喉镜,具有一定的临床应用价值。

Objective：To discuss the feasibility and clinical application value of the laryngeal iodine staining under the electronic fiber laryngoscope.Method：Will meet the inclusion criteria of 90 patients,randomly divided into three groups,set to a,b,c group.a,all patients in the a group were examined by electronic fiber mirror,NBI mode and 0.5% Lugol liquid iodine staining method in three ways.b,all patients in the b group were examined by electronic fiber mirror,NBI mode and 1.0% Lugol liquid iodine staining method in three ways.c,all patients in the c group were examined by electronic fiber mirror,NBI mode and 1.5% Lugol liquid iodine staining method in three ways.The location and range of positive lesions were recorded in each person of the three groups,positive lesions were biopsy,if the positive lesion is repeated,the site can only take a biopsy.As a diagnostic gold standard,the results of the other tests were compared with the results of other tests.And to observe the color of iodine in the throat,all patients were followed up for 24 hours in the presence of dyspnea,severe pain in the throat and other symptoms,and 24 hours after the examination again electronic fiber optic examination.Biopsy was performed in all patients,as gold standard.Using chi square test,inspection standard P0.05.Result：As the solution of the iodine concentration increased,the rate of the laryngeal was cancer gradually increased.Ninety people take part in the experiment,no one has serious complications.All the patients have no significant inflammation on the mucous membrane of the throat and the subglottic airway afer 24 hours,by the electronic fiber laryngoscope.1% and the following concentration of Lugol solution for iodine staining,sensitivity to the diagnosis of early laryngeal cancer was higher than that of electronic fiber,the two methods were compared,and the statistical analysis was performed（P〉0.05）.No statistical significance.There was no significant difference in the diagnosis of early laryngeal cancer.Contrast between iodine stain with 1.5% Lugol solution and electronic fiber sus pension,afterstatistical calculation（P〈0.05）;both are statistically significant,and the difference is significant.Comparison of iodine stain with 1.5% Lugol solution and NBI examination,make statistical analysis,P〉0.05,there was no significant difference between the both.Conclusion：The 1.5% and below the concentration of the iodine staining under the electronic fiber laryngoscope can be safely applied to inspect the throat,and 1.5% Lugol iodine solution in the diagnosis of laryngeal cancer in the early stage of laryngeal cancer is better than using electronic,and has a certain value in clinical application.