窄光成像膀胱镜在膀胱肿瘤诊断中的应用

目的 探讨窄光成像诱导光动力学检查对膀胱肿瘤早期诊断的应用价值. 方法 应用高清窄光成像膀胱镜系统对28例血尿患者进行膀胱镜检,术中分别对普通光下及窄光下的可疑部位膀胱黏膜组织活检,普通光组取样35处,窄光组取样79处(含普通光35处,普通光镜下疑似者窄光均显示镜下疑似,不重复取样)送病理检查.比较窄光取样组和普通光取样组肿瘤检出敏感性.结果 窄光取样组活检病理报告尿路上皮癌32处(21例),其中原位癌11处,腺性膀胱炎5处(2例),良性病变(炎性病变)3处(2例),正常黏膜4处(3例).普通光取样组尿路上皮癌17处(15例),腺性膀胱炎2处(1例),无原位癌.活检病理阳性32处,窄光组病理阳性32处,肿瘤检出率100%(32/32);普通光组病理阳性17处.肿瘤检出率53%(17/32);膀胱肿瘤及原位癌检出率2组比较差异有统计学意义(P<0.01).共取样79处,其中窄光组阳性32处,敏感性41%(32/79);普通光组阳性17处,敏感性22%(17/79),2组肿瘤取样敏感性比较差异有统计学意义(P<0.01). 结论 窄光成像膀胱镜能提高对膀胱肿瘤特别是原位癌的诊断敏感性,降低术中残存率,减少膀胱肿瘤复发危险性.

Detection of bladder cancer using narrow-band imaging induced endoscopy (report of 28 cases)

Objective To evaluate the value of photodynamic diagnosis for early detection of bladder cancer using narrow band imaging fluorescence cystoscopy. Methods A total of 28 cases of painless hematuria underwent narrow band imaging(NBI) endoscopy and biopsy. The procedure was as follows: biopsies were taken from lesions that were either fluorescing or nonfluorescing using endoscopy by NBI system) and then TUR was performed on them. Results Of the 28 cases, 79 biopsies were taken. Histopathologic examination showed that 32 of them were of urothelial cell carcinoma. Compared with white light cystoscopy, NBI had a sensitivity of 100% (32/32) ,flat small fluorescence positive lesions were found in peritumoral or other regions, which could not be detected by white light cystoscopy. Conclusion Photodynamic diagnosis using NBI fluorescence cystoscopy is useful for detection of early bladder cancer.