腹腔镜窄带成像技术在腹膜型子宫内膜异位症中的诊断价值

摘要

目的 探讨腹腔镜窄带成像技术(narrow band imaging,NBI)在腹膜型子宫内膜异位症(endometriosis,EMT)中的诊断价值.方法 选取2014年7月~2015年12月75例因盆腔包块或不明原因不孕或痛经在我院行腹腔镜检查和(或)手术治疗,分别于腹腔镜普通白光下和白光联合NBI模式下切除腹膜可疑病变及正常腹膜组织送病理组织学检查,比较白光与白光联合NBI 2种模式下对腹膜型EMT诊断的准确性.结果 白光下可见腹膜型EMT病灶77处,病理阳性70处;白光联合NBI下可见腹膜型EMT 98处,病理阳性89处;同时腹腔镜下表面正常的腹膜随机活检52处,病理阳性5处.白光下诊断腹膜型EMT与病理诊断一致性为0.584,一致性中等;白光联合NBI下诊断腹膜型EMT和病理诊断一致性为0.798,一致性较好.白光联合NBI诊断腹膜型EMT的敏感性为94.7%(89/94),显著高于白光74.5%(70/94)(χ2=14.719,P=0.000);准确性为90.7%(136/150),显著高于白光79.3%(119/150)(χ2=7.556,P=0.006);阴性预测值90.4%(47/52),显著高于白光67.1%(49/73)(χ2=9.222,P=0.002).结论 与白光比较,白光联合NBI下诊断腹膜型EMT有较高的准确性和敏感性,能识别更多的病灶,降低漏诊率,提高阴性预测值.%Objective To evaluate the diagnostic value of narrow band imaging ( NBI) in detecting peritoneal endometriosis. Methods This prospective study was performed in our hospital from July 2014 to December 2015. A total of 75 women undergoing laparoscopic evaluation for suspected endometriosis and/or unknown reason of infertility or dysmenorrhea were recruited in this study. They were given either ordinary white light ( WL) or white light with NBI mode ( WL+NBI) laparoscopic surgery. The peritoneal suspicious lesions and normal peritoneum tissue were removed and examined by histopathological examination. The accuracy of diagnosis was compared between the two modes for peritoneal endometriosis. Results There were 77 peritoneal endometriosis lesions under the WL, 70 of which were pathologically positive. There were 98 peritoneal endometriosis lesions under the WL+NBI, 89 of which were pathologically positive. Laparoscopic peritoneal biopsy was randomly performed in 52 cases of normal peritoneal surface, with 5 pathologically positive cases. The consistency of identifying peritoneal endometriosis lesions by WL and pathological results was 0. 584 and 0. 798 by WL +NBI and pathological results. The sensitivity of WL +NBI in diagnosing peritoneal EMT was 94. 7%(89/94), which was significantly higher than that of WL [74. 5% (70/94),χ2 =14. 719, P=0. 000]. The accuracy of WL+NBI in diagnosing peritoneal EMT was 90. 7% (136/150), which was significantly higher than that of WL [79. 3% (119/150),χ2 =7. 556, P=0. 006]. The negative predictive value of WL+NBI in diagnosing peritoneal EMT was 90. 4% (47/52), which was significantly higher than that of WL [67. 1% (49/73),χ2 =9. 222, P=0. 002]. Conclusion Laparoscopic diagnosis under WL+NBI has a higher degree of accuracy and sensitivity than under WL, which can identify more lesions, reduce missed diagnosis, and improve the negative predictive value.