窄带成像结肠镜诊断结直肠息肉样病变的临床价值

THE CLINICAL VALUE OF COLONOSCOPY NARROW-BAND IMAGING IN THE DIAGNOSIS OF POLYPOID LESIONS IN THE COLORECTUM

目的探讨窄带成像结肠镜(NBI)诊断结直肠息肉样病变的临床价值。方法于2014年1月—2015年12月结肠镜中心发现198例结直肠息肉样变,应用窄带成像结肠镜、常规白光内镜分别检查黏膜表面的腺管开口与血管形态,结果再与病理组织学检查进行对比。结果在198例患者中发现结直肠息肉样病变有257个,NBI内镜与常规白光内镜在黏膜表面分型的腺管开口的差异有统计学意义(P<0.05),NBI内镜明显优于白光内镜;NBI Kudo和佐野宁内镜对结直肠肿瘤性病变诊断的特异性、敏感性、符合率分别为:87.77%、91.52%、89.49%;89.20%、88.98%、89.11%,与白光内镜在特异性和符合率的差异有统计学意义(χ^(2a)=7.7887,Pa=0.005,χ^(2a)=5.5619,Pa=0.018;χ^(2b)=9.5149,Pa=0.002,χ^(2a)=5.1807,Pa=0.023);但三种检查方法的敏感性差异却无统计学意义(χ~2=2.4361,P=0.304)。与病理组织学检查相参照,NBI内镜明显优于常规内镜。结论 NBI内镜可以更加清晰显像结直肠息肉样病变的黏膜表明腺管开口以及微血管形态,可以更好地鉴别和诊断结直肠肿瘤,具有比较高的临床价值。

Objective To evaluate the clinical efficacy of the narrow-band imaging （NBI） colonoscopy in the diagnosis of colorectal polypoid lesions. Methods A total of 198 patients with eolorectal polypoid lesions detected by colonoscopy center were enrolled in the study from January 2014 to December 2015. And then application of narrow band imaging colonoscopy, regular white light endoscopy check respectively mucous membrane on the surface of the opening of the gland and the blood vessels form, the results compared with histologic examination again. Results Totally 257 colorectal polypoid lesions were found in 198 patients. There was significant statistical difference between NBI endoscopy and conventional white light endoscopy at aspect of the mucosal surface of the classification of the opening of the gland （P〈0.05）. NBI Kudo and sano endoscopic colorectal tumor lesion diagnostic specificity, sensitivity, the coincidence rate was respectively-87. 77% ,91.52% ,89.49% ;89.20% ,88.98% ,89.11% and at aspects of diagnostic specificity and the coincidence rate, there was statistical difference between NBI endoscopy and conventional white light endoscopy（χ^2a = 7. 7887, Pa = 0. 005, χ^2a = 5. 5619, Pa = 0. 018 ;χ^2b = 9. 5149, Pa = 0. 002, χ^2a = 5. 1807,Pa = 0. 023）, but as to the sensitivity of the three methods, there was no statistically significant difference（χ^2 = 2. 4361, P = 0. 304）. Compared with the histological examination, NBI endoscopy was superior to conventional endoscopy. Conclusions NBI endoscopy can make the image of polypoid lesions of the colorectal mucosa clearer in two respects of opening of the gland and the microvascular morphology and be better able to identify and diagnose colorectaI tumors. Therefore, NBI endoscopy has higher clinical value.