醋酸-靛胭脂染色在残胃病变胃镜检查中的临床应用

Clinical Value of Acetic Acid-Indigo Carmine Staining in the Diagnosis of Remnant Stomach Lesions

目的:观察胃大部切除术后残胃胃镜检查中,醋酸-靛胭脂染色对诊断及指导准确活检的价值,提高残胃早癌和癌前病变的检出率。方法:收集江汉大学附属医院310例胃大部切除术后行胃镜复查患者,随机选取156例为染色组,行醋酸-靛胭脂染色,记录染色情况,并予以电子放大内镜观察,然后取活检。154例为对照组,普通内镜检查及常规取活检,分析普通内镜、染色内镜检查与组织学之间的关系。比较染色组及对照组对病变检出率有无差异,分析染色情况与放大内镜观察胃小凹与微血管改变的关系。结果:染色组中,7例黏膜退色,早期胃癌或高级别上皮内瘤变的检出率为85.7%(6/7),74例黏膜染色不均,肠上皮化生和低级别上皮内瘤变的检出率为90.5%(67/74)。与对照组比,低级别上皮内瘤变和肠化检出率高(45.5%vs 23.7%,P<0.05),差异有统计学意义;早期胃癌及高级别上皮内瘤变检出率差异无显著性(3.8%vs 1.2%,P>0.05)。黏膜退色或染色不均对病变的检出率之和达到90.1%(73/81)。染色后,黏膜色泽变化与病变性质有一定的相关性。结论:经醋酸-靛胭脂染色,观察胃黏膜色泽的变化,显示病变,指导靶向活检,可提高残胃早癌及癌前病变的检出率。

Objective：To evaluate the clinical value of acetic acid-indigo carmine mixture dye in the diagnosis of remnant stomach lesions by using gastroscope,so as to increase the positive detection rate of early gastric cancer and precancerosis in the residual stomach.Methods：A total of 310 patients underwent partial gastrectomy were enrolled into this study,and randomly assigned to two groups.One hundred and fifty-six cases as observation group were stained with acetic acid-indigo carmine mixture dye,then we observed and took biopsy by magnifying endoscopy.The other 154 cases as control group were observed and sampled by conventional white light endoscopy without acetic acid-indigo carmine mixture staining.The relationship between conventional endoscope,staining endoscope and the histology were analyzed.The difference of positive detection rate between observation group and control group were compared and the correlation of staining results with changes of gastric foveola and capillaries under magnifying endoscopy was also evaluated.Results：In the staining group,6cases of remnant early gastric cancer and high grade intraepithelial neoplasia in 7cases of mucosa discoloration were detected（6/7,85.7% of detection rate）.Sixty-seven cases of intestinal metaplasia and low grade intraepithelial neoplasia were also appeared in total 74 cases of uneven,poor mucosa staining（67/74,90.5% of detection rate）.The detection rate of intestinal metaplasia and low-grade intraepithelial neoplasia in staining group was significantly higher than that of conventional group（45.5%vs 27.3%,P〈0.05）.The detection rate of high-grade intraepithelial neoplasia and early gastric cancer showed a slight increase in staining group compared with conventional group（3.8%vs 1.2%,P〉0.05）.Lesion detection rate reached90.1%（73/81）in mucosal discoloration together with poor staining.In addition,the changes of mucosal color and the lesional nature were correlated after acetic acid-indigo carmine mixture staining.Conclusion：Chromoendoscopy of acetic acid-indigo carmine mixture may guide a biopsy,then improve the detection rates of early gastric cancer and precancerous lesions in remnant stomach.