蓝激光成像结合放大内镜对内镜医生诊断上消化道早癌的价值研究

Diagnostic value of blue laser imaging combined with magnifying endoscopy for early cancer in upper gastrointestine

目的探讨蓝激光成像（Bu）结合放大内镜对不同年资内镜医生进行上消化道早癌诊断的价值。方法采用我院上消化道可疑病变病例行BLI精查，分别留取病灶处白光、BLI、BLI放大的图像，采用单盲法将图片分别给两组不同年资内镜医生独立观察，首先观察所有病灶的白光图片，然后再观察所有病灶的BLI和BLI放大图片，分别记录经白光观察和BLI观察的病灶边界，浸润深度、腺管结构和血管走形，再对病灶性质做出诊断。所有结果以术后病理诊断结果为金标准，与病理结果吻合的认为判断正确，否则认为是判断错误。最后统计分析两组医生用白光或BLI对病变诊断的差别。结果共18例患者纳入研究且均进行了ESD治疗，16例为肿瘤性病变。仅通过白光观察，低年资组医生对病灶边界判断的正确率为57％，而高年资组的准确率为74％，两组差异有统计学意义（X2=4．997，P=0．032），而通过BLI放大观察，低年资组和高年资组对病灶边界判断的准确率分别为90％和96％，两组差异无统计学意义（r=1．985，P=0．229）。使用白光观察，高年资组和低年资组医生对病灶性质判断的准确率分别为82％和66％（X2=5．431，P=0．022），而使用BLI放大观察后，两组医生对病变性质的判断均有所提高，准确率分别为97％和84％（X2=7．337，P=0．007），两组差异有统计学意义。但不论是使用白光观察还是BLI放大观察，两组医生对病变浸润深度的判断差异均无统计学意义。结论BLI结合放大内镜行胃镜精查可帮助内镜医生尤其是低年资内镜医生提高上消化道早癌的诊断水平。

Objective To explore the diagnostic value of blue laser imaging（BLI） combined with magnifying endoscopy for early cancer in upper gastrointestine in different levels of doctors. Methods A total of 18 patients with suspicious early upper gastrointestinal cancer underwent BLI magnifying endoscopy. All pictures of white light imaging and magnified BLI were observed by different levels of endoscopic doctors, who were divided into senior and junior groups. The boundary, invasive depth and type of the lesions were di- agnosed. All results were compared with final pathology results. The diagnostic accuracy rate was compared between two groups. Results All 18 patients underwent ESD and 16 cases were cancerous lesions. Accuracy rates of boundary diagnosis with white light imaging of junior and senior groups was 57% and 74%, respec- tively, and the difference was statistically significant （X2= 4. 997, P = 0. 032）. However, accuracy rates of the same lesions with magnified BLI of junior and senior groups were 90% and 96%, respectively （X2 = 1. 985, P = 0. 229）. The accuracy rates of lesion nature diagnosis with white light endoscopy of the two groups were 66% and 82%, respectively （X2 = 5.431, P = 0. 022）. However, by using BLI magnifying endoscopy, the accuracy rates were improved to 84% and 97% respectively （X2 = 7. 337 ,P= 0. 007）. But in terms of the invasion depth, the difference was not significant between two groups no matter what type of endoscopy was used. Conclusion BLI combined with magnifying endoscopy is useful for endoscopic doctors to improve the diagnostic accuracy in early upper gastrointestinal cancer, especially for junior endoscopic doctors.