窄带成像技术放大胃镜联合高频超声小探头在上消化道早癌及癌前病变诊断中的应用

摘要

Objective:To assess the diagnostic value of narrow-band imaging ( NBI) and magnifying endoscopy combined with endo-scopic ultrasonic miniature probe in upper-gastrointestinal early cancer and premalignant lesions.Methods:21 cases were probed with ordinary white light,NBI and amplification mode in terms of the range of lesions,gross morphology,microvascular morphology and open form of gland,and a small high frequency ultrasound probe was applied to detect the infiltration depth lesions.The obvious lesion was biopsied under NBI.A control study was conducted by comparing the histopathologic diagnosis and a statistical analysis was finally a-chieved.Results:21 lesions were found by routine endoscopy and 23 by NBI magnifying endoscopy.Under the guidance of NBI,the bi-opsy detected 9 cases (39.13%) of low-grade intraepithelial neoplasia (LGIN),8 cases (34.76%) of high-grade intraepithelial neo-plasia (HGIN),4 cases (17.39%) of carcinoma.20 in the 21 cases underwent high frequency ultrasound probe, which detected 12 cases (60%) of invaded mucosa,7 cases (35%) of invaded submucosa,1 case (5%) of invaded muscles.Based on comparison of the pit patterns between upper-gastrointestinal early cancer and premalignant lesions and chronic inflammation,the difference was significant (P<0.05).Conclusion:NBI and magnifying endoscopy combined with endoscopic ultrasonic miniature has a better accuracy rate in the diagnosis,and can diagnose the infiltrating depth of the lesion.Therefore,it is of great significance for guiding treatment and judging prognosis.%目的：探讨内镜窄带成像技术（ NBI）放大内镜联合超声小探头对上消化道早癌及癌前病变的诊断价值。方法：对21例患者分别以普通白光模式、NBI及放大模式对病灶进行观察，判断病灶的范围，大体形态，微血管形态及腺管开口形态，再于高频超声小探头对病灶进行探查判断其浸润深度，检查结束后在NBI模式下对病灶明显处进行活检，将NBI联合放大内镜下微血管形态及腺管开口形态结果，联合高频超声小探头所判断的病灶浸润深度与组织病理诊断对照研究后进行统计学分析。结果：常规内镜和NBI＋放大内镜分别发现病灶21处和23处，NBI指导活检病理诊断低级别上皮内瘤变9例（39.13％），高级别上皮内瘤变8例（34.76％），癌4例（17.39％）。21例中20例行高频超声小探头探查，病灶局限于黏膜层12例（60％），累及黏膜下层7例（35％），累及固有肌层1例（5％）。上消化道早癌及癌前病变的pit pattern与慢性炎症的pit pattern分型比较，差异有统计学意义（ P＜0.05）。结论：窄带成像放大内镜联合高频超声小探头有助于提高上消化道早癌及癌前病变诊断的准确度，并可准确判断病变的浸润深度，对指导治疗及判断预后具有重要意义。