色素内镜-食管多原发癌早期诊断的有效手段

摘要

目的 分析不同内镜检查方法对食管多原发癌(multiple primary esophageal carcinoma,MPEC)的诊断价值.方法 回顾性分析近5年在中国人民解放军总医院海南分院行胃镜检查经病理诊断证实为食管鳞癌或食管鳞状高级别上皮内瘤变患者资料,比较不同检查方法对同时性食管多原发癌synchronous multiple primary esophageal carcinoma, SMPEC)的识别效果.结果 1 084例食管肿瘤患者中,SMPEC占10.52%(114/1 084).白光、卢戈氏液染色、单用NBI观察以及卢戈氏液与NBI联合检出MPEC所占比例分别为6.01%、17.59%、10.91%、16.79%,卢戈氏液组、联合组MPEC检出率高于白光组与NBI组.在114例SMPEC患者中,共发现病变236个,其中进展期食管癌150个,食管早癌86个,四组食管早癌构成比分别为17.65%、46.34%、21.05%、52.81%,卢戈氏液组、联合组早癌检出率明显高于白光组和NBI组.结论 卢戈氏液食管染色及卢戈氏液联合NBI进行观察比单独应用白光及NBI更易检测出SMPEC,尤其是食管早癌.%Objective To evaluate the diagnostic value of different endoscopic methods for multiple primary esophageal carcinoma (MPEC).Methods The data of patients who underwent endoscopy in Hainan Branch of Chinese PLA General Hospital with esophageal squamous cell carcinoma or esophageal high grade intraepithelial neoplasia confirmed by pathology in recent 5 years were analyzed retrospectively.The diagnosis rates of synchronous multiple primary esophageal carcinoma (SMPEC) with different methods were compared.Results In 1 084 cases of esophageal cancer, the proportion of SMPEC was 10.52% (114/1 084).In white light, Lugol chromoendoscopy, NBI and Lugol chromoendoscopy combined with NBI, the proportions of MPEC were 6.01%, 17.59%, 10.91%, 16.79%, respectively.The proportion of MPEC in Lugol chromoendoscopy group and combined group was higher than that in white light group and NBI group.In the 114 SMPEC patients, 236 lesions were found, among which 150 were advanced esophageal cancer and 86 were early esophageal cancer.The proportions of early esophageal cancer in four groups were 17.65%, 46.34%, 21.05%, 52.81%, respectively.The proportion of early esophageal cancer in lugol chromoendoscopy group and combined group was significantly higher than that in white light group and NBI group.Conclusion Lugol chromoendoscopy and combined with NBI are more sensitive than white light or NBI in diagnosis of SMPEC, especially those with early esophageal cancer.