放大内镜联合内镜智能分光比色技术对胃癌及癌前病变的诊断价值

目的: 探讨放大内镜联合富士能电子分光内镜技术(FICE)对胃癌及癌前病变的诊断价值.方法: 收集消化内镜检查患者109例,共116处病灶,用放大内镜联合FICE技术及染色放大内镜观察胃黏膜腺管开口和微血管形态,将其分为6型(Ⅰ~Ⅲ型为胃黏膜腺管结构清晰,微血管形态分别为规则清晰、不规则、模糊不清;Ⅳ~Ⅵ型为胃黏膜腺管结构不规则模糊,微血管形态分别为规则清晰、不规则、模糊不清),并行活检组织学病理检查,将分型结合病理结果进行分析.结果: FICE放大内镜对腺管开口分型的诊断优于常规放大内镜(P< 0.01);FICE放大内镜与染色放大内镜图像相比,能更清晰显示胃黏膜微细血管形态结构(P< 0.01),两者在显示腺管开口方面差异无统计学意义(P >0.05).胃黏膜腺管开口规则清楚的病灶中(Ⅰ～Ⅲ型)均未发现癌变,仅有1例高级别内瘤变;高级别内瘤变及癌变均集中于胃黏膜腺管开口不规则模糊病灶中(Ⅳ～Ⅵ型).结论: 利用放大内镜联合FICE技术观察胃黏膜细微结构,能更加精确地引导活检,提高胃癌内镜诊断的准确性.

The value of magnifying endoscopy combined with Fuji intelligent chromoendoscopy in the diagnosis of gastric cancer and precancerous lesions

Objective: To evaluate the value of magnifying endoscopy combined with Fuji intelligent chromoendoscopy(FICE) in the diagnosis of gastric cancer and precancerous lesions.Methods: The gastric mucosa gland openings and microvascular morphology in 109 patients(116 lesions) were detected by magnifying endoscopy combined with FICE,all cases were divided into six types according to the examination result.The clear gastric mucosa gland,clear and regular or irregular and unclear microvascular pattern were the main manifestations of types Ⅰ,Ⅱ and Ⅲ,the unclear and irregular gastric mucosa gland,clear and regular or irregular and unclear microvascular pattern were the main manifestations of types Ⅳ,Ⅴ and Ⅵ.The pathological results of different types were analyzed.Results: The type diagnosis of gastric mucosa gland using magnifying FICE was better than that using normal endoscope(P< 0.01).Compared with the magnifying chromoendoscopy,the magnifying FICE could clearly show the microvascular pattern(P< 0.01),the difference of the identifying the gastric mucosa gland opening between two methods was not statistically significant(P >0.05).Except for 1 HGD case,the canceration in case with clear and regular gastric mucosa gland opening(typeⅠto Ⅲ) was not found.The HGD and canceration located mainly in cases with unclear and irregular gastric mucosa gland opening(type Ⅳ to Ⅵ).Conclusions: Observing the microstructure of gastric lesions using magnifying FICE can guide the accurate biopsy,and improve the accuracy of diagnosing in gastric cancer.