窄带成像结合染色放大内镜对提高溃疡性结肠炎并发结肠炎性相关癌检出率的研究

Study on the detection rate of ulcerative colitis complicated with colitis associated cancer by narrow-band imaging combined with dyed magnification endoscopy

目的探讨窄带成像结合染色放大内镜对提高溃疡性结肠炎并发结肠炎性相关癌(UC-CRC)检出率的临床价值。方法 2011年1月~2016年12月间,在我院消化内科门诊及住院诊治的溃疡性结肠炎并发结肠炎性相关癌30例,其中2例肠道准备不佳(未进行清晰显像)、2例无完整的白光与NBI下活检结果被删除,最终共26例纳入回顾性研究。男14例,女12例;年龄45岁~70岁,平均(49.8±4.6)岁。分别在普通模式以及内镜NBI模式+染色放大内镜下行电子内镜观察结肠黏膜的变化,比较两种检查模式对UCCRC诊断的敏感度、特异度及准确度。数据采用χ2检验进行分析。结果 26例UC-CRC诊断年龄距UC诊断时间为14~21年;UC-CRC部位分别为直肠、乙状结肠、横结肠、升结肠;既往UC均为全结肠炎、慢性复发型。内镜下UC-CRC表现为癌变病变部位均有溃疡形成和不同程度的肠腔狭窄,其他肠段呈活动性UC表现。病理诊断均为腺癌,分化程度以中-低分化为主,其中5例术后病理发现两个部位癌灶。26例均接受手术治疗,CRC分期为T4N1M1,T3N1M0,T2N0M0,T4N1M0;12例患者术后5、27个月死于CRC广泛转移;另14例术后随访8、44个月健康生存。内镜NBI模式+染色放大内镜对溃疡性结肠炎并发结肠炎性相关癌诊断符合率92.3%,NBI普通模式诊断符合率为46.2%,内镜NBI模式+染色放大内镜诊断符合率明显高于NBI普通模式(χ2=4.17,P<0.05)。结论 UC-CRC的诊断较晚,预后差;内镜下不规则的溃疡和狭窄可能提示CRC病变;NBI放大内镜和染色放大内镜能更为清晰地显示病变轮廓、微血管形态,且操作转换简单快捷,两种检查方法互补可作为当前鉴别大肠病变是否为肿瘤性的重要手段。

Objective To explore the clinical value of narrow band imaging combined with dye magnifying endoscopy in improving the detection rate of ulcerative colitis complicated with colitis associated cancer(UC-CRC).Methods There were 30 cases of ulcerative colitis complicated with colitis related cancer who were diagnosed and treated in the outpatient department of our hospital from January 2011 to December 2016.2 cases were poorly prepared for bowel preparation(no clear imaging),and 2 cases without complete white light and NBI biopsy were deleted.Finally,a total of 26 cases were included in the retrospective study.There were 14 males and 12 females,aged from 45 to 70 years,with an average age of(49.8±4.6)years.The changes in the colonic mucosa were observed under the common model and endoscopic NBI mode+dyed endoscopy.The sensitivity,specificity and accuracy of the two models for the diagnosis of UC-CRC were compared.The data were analyzed by theχ2 test.Results The diagnosis of age range UC in 26 cases with UC-CRC was 14-21 years.The UC-CRC parts were rectum,sigmoid colon,ascending colon,transverse colon;previous UC were all colitis,chronic relapsing.Endoscopic UC-CRC showed that there were ulceration and varying degrees of intestinal stenosis in the site of cancerous lesions,and the other intestinal segments showed active UC.The pathological diagnosis was adenocarcinoma,and the degree of differentiation was mainly medium to low differentiation,and two sites were found in 5 cases after operation.All 26 cases were treated with surgical treatment.The CRC staging was T4N1M1,T3N1M0,T2N0M0,T4N1M0;12 patients died of extensive CRC metastasis in 5 months and 27 months after operation.The other 14 cases were followed up for 8 months and 44 months.The diagnosis of ulcerative colitis associated with colitis associated cancer was 92.3%by endoscopic NBI model+dyed magnification endoscopy.The diagnostic coincidence rate of NBI general model was 46.2%,and the diagnostic coincidence rate of endoscopic NBI model+staining magnifying endoscopy was significantly higher than that of NBI normal mode(χ2=4.17,P<0.05).Conclusion The diagnosis of UC-CRC is late and the prognosis is poor;irregular ulcers and strictures under endoscopy may suggest CRC lesions.NBI magnifying endoscopy and dye magnifying endoscopy can clearly show the outline and microvascular morphology of lesions,and the operation transformation is simple and quick.The complementary of the two methods can be used as an important way to identify whether colorectal lesions are tumor.