窄带成像技术在胃黏膜高级别上皮内瘤变内镜黏膜下剥离术中的应用价值

Safety and effectiveness of NBI combined with ESD in treatment of gastric mucosa HGIN

目的考察窄带成像技术(NBI)在胃黏膜高级别上皮内瘤变内镜黏膜下剥离术(ESD)中的应用价值。方法选择2011年10月至2017年9月武警河南总队医院收治的221例高级别胃黏膜上皮内瘤变(HGIN)患者,根据术前检查方式不同将患者分为NBI组(113例)与白光内镜(WLE)组(98例),两组患者均接受ESD术治疗。比较两组患者术前内镜图像清晰程度、手术一般情况、围术期并发症及随访复发与生存情况。结果NBI组对黏膜微血管形态与病变轮廓的图像清晰程度高于WLE组,差异有统计学意义(P<0.01),两组胃小凹形态的图像质量差异无统计学意义(P>0.05);NBI组手术时间(52.37±20.23)分,少于WLE组的(72.14±19.86)分,差异有统计学意义(P<0.05);NBI组切除的病灶直径、一次性整块切除率、治愈性切除率均高于WLE组,差异有统计学意义(P<0.05);术后随访,NBI组复发率0.88%、并发症发生率5.31%,均低于WLE组的11.22%、25.51%,差异均有统计学意义(P<0.05)。结论对于ESD治疗胃黏膜HGIN患者,WLE可实现病灶范围的精确标记与环切剥离,缩短手术时间,提升病灶切除的有效性及手术安全性。

Objective To investigate the value of Narrowband imaging (NBI) in Endoscopic submucosal dissection (ESD) for gastric mucosal high-grade intraepithelial neoplasia. Methods A total of221 patients with gastric mucosal HGIN admitted to Henan Armed Police Corps Hospital from Octo 2011 to Sept 2017 were selected.According to the different ways of preoperative examination, 113 patients were divided into NBI group and 98 patients in WLE group. Both groups received ESD treatment,thenthe clarity of preoperative endoscopic images, the general situation of operation, perioperative complications,recurrence and survival during the follow-upwere compared. Results ompared with WLE, the image clarity score of NBI was significantly higher for the mucosal microvascular morphology and pathological contour ( P <0.01), but there was no statistical significance in image quality of gastric small concave between two kinds of endoscopy ( P > 0.05 ).In WLE group, the operation time was (72.14±19.86) min, the diameter of the lesion was (3.81±1.09) cm, the one-time resection rate was 90.82%, and the cure resection rate was 84.69%, while those in NBI groupwas (52.37±20.23) min,(5.87±2.14) cm, 100.00%, and 93.81%,respectively, and the difference was statistically significant( P <0.05). In NBI group, the operative time was shorter, the diameter of lesions was larger, and the one-time excision rate and curative resection rate werehigher, and the difference was statistically significant( P <0.05).During the follow-up after surgery, the recurrence rate of NBIgroup was 0.88% andthe incidence of surgical complications was 5.31%, both of which were lower than those of WLE group(11.22%, 25.51%), and the difference was statisticallysignificant( P <0.05). Conclusion NBI combined with ESD in the surgical treatment of gastric mucosa HGIN can achieve accurate markers and circumferential dissection of the lesion area based on clearer endoscopic images, and thereby significantly shorten the operation time and improve the efficacy and safety of the lesion resection.