碘染色用于早期食管癌及癌前病变高危人群筛查的临床研究

Clinical study of endoscopic screening by iodine staining for high risk populations of early esophageal cancer and precancerous lesions

目的探讨内镜下碘染色对早期食管癌及癌前病变筛查及诊断的效果。方法选取2018年4-7月有食管癌高危因素的患者进行内镜下碘染色检测,观察并记录碘染色前后食管黏膜情况,并对病变部位行指示性活检,获取组织病理学结果并分析。结果 203例患者纳入研究,发现食管病变25例(12.3%),其中食管炎19例(9.3%),低级别上皮内瘤变2例(1.0%),高级别上皮内瘤变4例(2.0%)。碘染色后的淡染区和不染区多出现在染色前粗糙、糜烂、发红、凹陷不规则的黏膜处。白光下早期癌变及癌前病变主要表现为黏膜发红、粗糙、凹陷不规则,而食管炎多表现为正常黏膜或黏膜粗糙、糜烂。食管早期癌变均出现在不染区,且粉红色征均为阳性。结论内镜下碘染色可应用于高危人群筛查食管早期癌变及癌前病变。在内镜检测时,应对白光下发红、粗糙、凹陷不规则的黏膜,碘染色后淡染及不染区的黏膜,以及粉红色征阳性的部位,进行靶向活检,以帮助早期食管癌及癌前病变的诊断。

Objective To evaluate the clinical diagnostic value of endoscopic screening by iodine staining on early esophageal cancer and precancerous lesions.Methods Endoscopic iodine staining was performed in patients with high risk factors of esophageal cancer from April 2018 to July 2018.The esophageal mucosa was observed and recorded before and after taking iodine staining,and targeted biopsy was performed on the lesion to obtain histopathological results and make analysis.Results A total of 203 patients enrolled in study and were found 25 (12.3%) cases of esophageal lesions,including 19 (9.3%) cases of esophagitis,2 (1.0%) cases of low grade intraepithelial neoplasia,and 4 (2.0%) cases of high grade intraepithelial neoplasia.The areas of light-stained and non-stained were mostly found in rough,erosive,reddish,concave and irregular esophageal mucosa under white light endoscopy.Endoscopy imaging of early esophageal cancer and precancerous lesions were mainly manifested as redness,roughness and irregular depression of mucosa under white light endoscopy.However,endoscopy imaging of esophagitis often showed as normal mucosa,roughness and erosion of mucosa.In this study,all of the early esophageal cancer lesions were found in the non-stained areas,and the pink signs of the mucosa were positive.Conclusion The iodine staining can apply for screening early esophageal cancer and precancerous lesions in high risk populations.During endoscopic examination,the red,rough,and concave irregular mucosa,the light-stained and non-stained areas with iodine staining,and the pink sign positive sites should be targeted for biopsy,to improve the diagnosis of early esophageal cancer and precancerous lesions.