智能分光电子染色内镜联合小探头超声在食管浅表性病变诊治中的应用价值

Flexible spectral imaging color enhancement associated with miniprobe endoscopic ultrasonography in diagnosis of superficial esophageal lesions

目的研究智能分光电子染色(FICE)内镜联合小探头超声内镜(EUS)在诊断食管浅表性病变中的临床价值。方法选取2013年1月-2016年6月该院消化内镜中心行普通白光胃镜检查可疑食管黏膜病变患者为研究对象,共292例,将患者按随机数字法分为观察组和对照组,各146例,对照组采用普通白光放大内镜进行检查,观察组在对照组检查基础上应用FICE放大内镜及小探头EUS,观察病变处食管上皮乳头内毛细血管袢(IPCL)的改变及病变深度,并推测病理类型,将两组内镜诊断结果与病理组织学诊断结果进行对比分析。结果 FICE放大内镜可清晰观察食管IPCL形态并分型,FICE内镜对食管炎性病变诊断的符合率为82.69%,轻中度不典型增生符合率为82.22%,重度不典型增生符合率为86.96%,食管癌符合率为100.00%。观察组与对照组准确率分别为91.78%和76.02%;灵敏度分别为85.71%和44.44%,前者明显优于后者。FICE内镜发现5处白光内镜漏诊的平坦型病变。结论 FICE模式与普通白光内镜相比,可增强病变的可识别性,能清楚显示病变轮廓和形态,能有效提高活检的准确性,操作方便。FICE联合小探头EUS在食管浅表性病变诊断治疗方面有一定的临床应用价值。

Objective To evaluate the flexible spectral imaging color enhancement (FICE) system associated with mini-probe endoscopic ultrasonography in diagnosis of superficial esophageal lesions. Methods 292 patients with superficial esophageal lesions were randomly assigned to control group or observation group. The common white light endoscopy and magnifying endoscopy were used in the control group while FICE associated with mini-probe endoscopic ultrasonography in the observation group. Findings were compared with the pathologic diagnosis. Result The magnifying FICE could reveal the IPCL of superficial esophageal lesions and can accurately determine the pathological types of lesions. The diagnose accordance rate of esophagitis by magnifying FICE was 82.69%, mild and moderate atypical hyperplasia highly atypical hyperplasia 86.96%. The diagnostic accuracy rate of esophagus lesions between observation group and control group was 91.78 %, 76.02 % respectively. And the diagnostic sensitive rate between two groups was 85.71%, 44.44%. The former is superior to the latter. There were 5 flat lesions found by FICE which were missed diagnosed by white light endoscopy. Conclusion FICE can enhance the ability of identification of lesion which shows the outline and morphology of lesion and can improve the biopsy accuracy. FICE associated with mini-probe endoscopic ultrasonography has a certain clinical application value in the diagnosis and treatment of superficial esophageal lesions.