醋酸联合靛胭脂染色的2种方式对判别早期胃癌边界的比较

A comparative study of two methods of the chromoendoscopy with the acetic acid and indigo carmine for identifying a demarcation line of early gastric cancer

[目的]比较醋酸靛胭脂混合(AIM)染色与醋酸靛胭脂顺序(AI)染色方法判别早期胃癌边界效果的差异。[方法]将通过胃镜活检确诊的100例早期胃癌患者随机分成AIM组、AI组,各50例,分别行AIM染色和AI染色,记录染色前后病变边界的清晰程度,并在染色异常区及边缘染色正常区取活检,比较2种染色方法显示早期胃癌边界准确度的差异。[结果]AIM组、AI组肉眼判别早期胃癌边界的准确率分别为76.0%、88.0%(P>0.05),二者显示早期胃癌边界的病理准确率分别为58.0%、78.0%(P<0.05);相比于白光胃镜,AIM染色、AI染色均可显著提高高分化腺癌边界判别的准确率(P<0.05),与AIM染色比较,AI染色更能显著提高高分化腺癌边界判别的准确率(P<0.05);AIM染色、AI染色对低分化腺癌的判别准确率却与普通白光胃镜比较差异无统计学意义(P>0.05)。[结论]AIM染色、AI染色方法均能提高胃早期高分化腺癌边界判别的准确率,同时AI染色比AIM染色更能清晰的显示病变的边界,方便准确的指导内镜下黏膜剥离术。

[Objective]Compare the difference of the two methods of the chromoendoscopy with the acetic acid indigocarmine mixture（AIM）and indigo carmine dye added to acetic acid（AI）for identifying a demarcation line of early gastric cancer. [Methods]We prospectively included 100 lesions of 100 patients that had an endoscopic diagnosis of EGC. All the patients were randomly divided into two groups,each group 50 cases. Before endoscopic submucosal dissection （ESD） or laparoscopic gastrectomy,one group of patients were examined by conventional endoscopy and AI chromoendoscopy,and the other group of patients were examined by conventional endoscopy and AIM chromoendoscopy. The border clarification between the lesion and the normal mucosa was classified as distinct or indistinct before and after AI chromoendoscopy and AIM chromoendoscopy. [Result] Through image comparison, the borders of the lesions were distinct in 88 % with AI chromoendoscopy and in 76% with AIM chromoendoscopy （p〉0. 05）. Through pathology comparison,the borders of the lesions were accurate in 78% with AI chromoendoscopy and in 58% with AIM chromoendoscopy （P〈0. 05）. Compared with conventional endoscopy, AI chromoendoscopy and AIM chromoendoscopy clarified the border in a significantly higher percentage of differentiated adenocarcinomas （94. 7 % vs 77. 8% , respectively） . Especially, AI chromoendoscopy clarified the border in a significantly higher percentage of differentiated adenocarcinomas than AIM chromoendoscopy（P〈0. 05）. However, the border clarification rate for undifferentiated adenocarcinomas showed no difference between AIM chromoendoscopyand AI chromoendoscopy （P 〉 0.05）. [Conclusion] AI chromoendoscopy and AIM chromoen- doscopy could clarify the border in a significantly higher percentage of differentiated adenocarcinomas than conventional endoscopy. Especially,AI chromoendoscopy clarified the border in a significantly higher percentage of differentiated adenocarcinomas than AIM chromoendoscopy,and it could provide convenient and accurate guidance for endoscopic ESD surgery.