染色内镜结合超声内镜在早期食管癌及癌前病变诊治中的价值

The value of endoscopy combined with endoscopic ultrasonography in the diagnosis and treatment of early esophageal cancer and precancerous lesions

目的探讨窄带成像技术(NBI)、碘染色结合超声内镜(EUS)在早期食管癌及癌前病变诊断和治疗中的价值。方法对可疑食管病变的患者分别进行NBI及碘染色检查,并对病灶进行活检,统计NBI及碘液染色法对早期食管癌及癌前病变的检出率及联合检出率。对食管癌和癌前病变的患者进行EUS检查,判断病变的浸润深度,选择合适的治疗方式(内镜下微创治疗或手术治疗),术后将切除的病变组织行病理检查,比较病变浸润深度与超声内镜判断的浸润深度的符合率。结果单独采用NBI与单独使用碘染色法对早期食管癌及癌前病变的检出率差异无统计学意义(P>0.05),NBI结合碘染色方法的早期食管癌及癌前病变检出率显著优于单独应用NBI或碘染色法(P<0.05)。EUS判断食管病变浸润深度的准确性与病理结果相比较,差异无统计学意义(P>0.05)。结论 NBI结合碘染色法可以提高早期食管癌及癌前病变的检出率,超声内镜可以对病变的浸润深度做出准确判断,为治疗方案的选择提供较为可靠的依据。

Objective To evaluate the value of narrow band imaging(NBI),iodine staining and endoscopic ultrasonography(EUS)in the diagnosis and treatment of early esophageal cancer and precancerous lesions.Methods Patients with suspected esophageal lesions were examined by NBI and iodine stain respectively.Biopsy of the lesion was performed.The detection rate and joint detection rate of NBI and iodine solution staining for early esophageal cancer and precancerous lesions were statistically analyzed.EUS scan was performed in patients with esophageal cancer and precancerous lesions to determine the depth of invasion and select the appropriate treatment(endoscopic minimally invasive treatment or surgical treatment).After operation,the pathological examination was performed on the resected lesion tissue,and the coincidence rate between the depth of lesion infiltration and the depth of lesion infiltration determined by ultrasound endoscopy was compared.Results There was no significant difference in the detection rate of early esophageal cancer and precancerous lesions between NBI alone and iodine staining alone(P>0.05).The detection rate of NBI combined with iodine staining for early esophageal cancer and precancerous lesions was significantly better than that of NBI or iodine staining alone(P<0.05).The accuracy of EUS in judging the depth of invasion of esophageal lesions was not statistically different from that of pathological findings(P>0.05).Conclusion NBI combined with iodine staining can improve the detection rate of early esophageal cancer and precancerous lesions.Endoscopic ultrasonography can accurately predict the depth of invasion,and provide a reliable basis for the selection of treatment plan.