窄带成像联合放大内镜在食管癌临床诊治中的应用价值探讨

Application value of narrow band imaging combined with magnifying endoscopy in the clinical diagnosis and treatment of esophageal cancer

目的探究窄带成像联合放大内镜(NBI-ME)在食管癌临床诊治中的应用价值。方法回顾性分析2014年2月至2019年12月衢州市人民医院162例行内镜黏膜下剥离术(ESD)治疗患者临床资料,其中经NBI-ME引导下ESD治疗84例(观察组),普通白光内镜碘染色引导下ESD治疗78例(对照组)。比较两组术前诊断与术后病理诊断结果差异,并记录两组手术相关指标(手术时间、标记时间、黏膜分离时间、创面处理时间)、临床疗效。结果NBI-ME术前诊断准确64例(76.19%),普通白光内镜碘染色术前诊断准确46例(58.97%),NBI-ME术前诊断准确率明显高于普通白光内镜碘染色(P<0.05)。两组术中标记时间比较,差异无统计学意义(P>0.05);观察组手术时间、黏膜分离时间、创面处理时间均低于对照组(P<0.05)。两组整块切除率比较,差异无统计学意义(P>0.05);两组术前诊断低级别上皮内瘤变者(LGIN)完全切除率比较,差异无统计学意义(P>0.05),但观察组术前诊断高级别上皮内瘤变(HGIN)及食管癌者完全切除率均高于对照组(P<0.05)。结论NBI-ME不仅在食管癌术前诊断中应用效果较好,且能引导ESD治疗,提高手术效率及完全切除率,在食管癌诊疗中应用价值较高。

Objective To explore the application value of narrow band imaging combined with magnifying endoscopy(NBIME)in the clinical diagnosis and treatment of esophageal cancer.Methods The clinical data of 162 patients who underwent endoscopic submucosal dissection(ESD)in Quzhou People’s Hospital from February 2014 to December 2019 were retrospectively analyzed.Among them,84 patients were given ESD under NBI-ME guidance(observation group),and 78 patients were given ESD under ordinary white light endoscopic iodine staining guidance(control group).The differences in results of preoperative diagnosis and postoperative pathological diagnosis were compared between the two groups,and the surgery-related indicators(surgical time,marking time,mucosal separation time,wound treatment time)and clinical efficacy were recorded in the two groups.Results 64 cases(76.19%)were accurately diagnosed by NBI-ME before surgery,and 46 cases(58.97%)were accurately diagnosed by ordinary white light endoscopic iodine staining,and the accuracy rate of preoperative diagnosis of NBI-ME was significantly higher than that of ordinary white light endoscopic iodine staining(P<0.05).There was no statistically significant difference between the two groups in the intraoperative marking time(P>0.05).The surgical time,mucosal separation time and wound treatment time in observation group were all lower than those in control group(P<0.05).There was no statistically significant difference in the en bloc resection rate between the two groups(P>0.05).There was no significant difference in the complete resection rate between the two groups in the preoperative diagnosis of low grade intraepithelial neoplasia(LGIN)patients(P>0.05),but the complete resection rates in observation group in the preoperative diagnosis of high grade intraepithelial neoplasia(HGIN)patients and esophageal cancer patients were higher than those in control group(P<0.05).Conclusion NBI-ME not only has a good application effect in the preoperative diagnosis of esophageal cancer,but also can guide ESD treatment,improve the surgical efficiency and complete resection rate,and has a high application value in the diagnosis and treatment of esophageal cancer.