根治幽门螺杆菌对早期胃癌内镜诊断的影响

Effects of radical treatment of Helicobacter pylori on endoscopic diagnosis of early gastric cancer

目的探索根治幽门螺杆菌(Helicobacter pylori,HP)对传统白光内镜、醋酸靛胭脂染色内镜及窄带光成像放大内镜诊断早期胃癌的影响。方法2013年1月至2018年3月,于武汉大学人民医院鄂州医院消化内科或华中科技大学同济医学院附属协和医院消化内科拟行内镜检查,HP阴性(于6个月前成功根治)和HP阳性(近6个月未曾行HP根治治疗)者纳入研究,按普通"白光-醋酸靛胭脂染色-窄带光成像放大"流程行内镜检查,在最终经组织学病理确诊为早期胃癌的患者中,连续收集HP阴性(于6个月前成功根治)和HP阳性(近6个月未曾行HP根治治疗)患者各120例,分别纳入HP成功根治组和未行HP根治组。对2组早期胃癌的白光内镜、醋酸靛胭脂染色内镜、窄带光成像放大内镜检出率行统计学分析。结果2组间病例医院来源构成(χ^2=2.637,P=0.104)、患者性别构成(χ^2=0.074,P=0.785)、患者平均年龄(t=0.582,P=0.561)、病变形态构成(χ^2=0.179,P=0.914)比较,差异均无统计学意义。普通白光内镜、醋酸靛胭脂染色内镜、窄带光成像放大内镜的早期胃癌检出率,HP成功根治组中分别为75.0%(80/120)、57.5%(69/120)、90.0%(108/120),未行HP根治组中分别为81.7%(98/120)、93.3%(112/120)、98.3%(118/120)。HP成功根治组早期胃癌的普通白光内镜检出率(χ^2=7.046,P=0.008)、醋酸靛胭脂染色内镜检出率(χ^2=41.554,P<0.001)、窄带光成像放大内镜检出率(χ^2=7.585,P=0.006)均明显低于未行HP根治组。HP成功根治组中,醋酸靛胭脂染色内镜的早期胃癌检出率最低,低于普通白光内镜(χ^2=2.142,P=0.143)及窄带光成像放大内镜(χ^2=32.736,P<0.001),而窄带光成像放大内镜的早期胃癌检出率最高,高于普通白光内镜(χ^2=19.247,P<0.001)。结论根治HP后早期胃癌的普通白光内镜、醋酸靛胭脂染色内镜和窄带光成像放大内镜诊断变得更加困难,尤其是对醋酸靛胭脂染色内镜的影响更为明显。上述3种内镜检查方法中,窄带光成像放大内镜的诊断效能最高,适合于根治HP后早期胃癌的临床诊断。

Objective To investigate the effects of Helicobacter pylori(HP)radical treatment on diagnosis of early gastric cancer using conventional white light endoscopy(WLE),chromoendoscopy of indigo carmine dye added to acetic acid,and magnifying endoscopy with narrow band imaging(ME-NBI).Methods Between January 2013 and March 2018,patients without HP(successful cured before six months)or with HP(no radical treatment for HP in recent 6 months),who underwent endoscopy examinations in the Department of Gastroenterology of Ezhou Hospital,People′s Hospital of Wuhan University or the Department of Gastroenterology of Union Hospital,Tongji Medical College Huazhong University of Science and Technology were enrolled in the study.Endoscopy examinations were performed according to the order of conventional WLE,chromoendoscopy using indigo carmine dye added to acetic acid,and ME-NBI.Among the patients finally diagnosed as early gastric cancer by histopathology,120 patients without HP and 120 patients with HP were continuously collected,and included in the radical treatment group and the non-radical treatment group,respectively.Diagnostic reliabilities of WLE,chromoendoscopy,and ME-NBI for early gastric cancer between the two groups were statistically analyzed.Results There were no statistical differences between the two groups in terms of hospital source(χ^2=2.637,P=0.104),gender composition(χ^2=0.074,P=0.785),mean age(t=0.582,P=0.561),and lesion morphology(χ^2=0.179,P=0.914).The detection rates of early gastric cancer in the radical treatment group using WLE[75.0%(80/120)VS 81.7%(98/120),χ^2=7.046,P=0.008],chromoendoscopy[57.5%(69/120)VS 93.3%(112/120),χ^2=41.554,P<0.001],and ME-NBI[90.0%(108/120)VS 98.3%(118/120),χ^2=7.585,P=0.006]were significantly lower than those in the non-radical treatment group.In the radical treatment group,chromoendoscopy had the lowest detection rate of early gastric cancer,followed by WLE(χ^2=2.142,P=0.143)and ME-NBI(χ^2=32.736,P<0.001),while ME-NBI had the highest detection rate of early gastric cancer,which higher than that of WLE(χ^2=19.247,P<0.001).Conclusion The diagnosis of early gastric cancer by WLE,chromoendoscopy using the indigo carmine dye added to acetic acid and ME-NBI becomes more difficult after radical treatment of HP.Among the above three endoscopic methods,ME-NBI has the highest diagnostic efficacy,and becomes the first choice for the clinical diagnosis of early gastric cancer after radical treatment of HP.