内镜窄带成像技术在胃癌及癌前病变诊断中的应用

目的 探讨内镜窄带成像技术(NBI)对胃癌及癌前病变的诊断价值.方法 217例患者依次在普通内镜、NBI、0.2%靛胭脂染色及内镜放大(×80)模式下观察病变轮廓、胃小凹及微血管形态,评价各检查方法图像的清晰度,并结合病理学检查进行分析.结果 217例患者中,非萎缩性胃炎85例,萎缩性胃炎38例,轻度异型增生19例,中度异型增生9例,重度异型增生4例,早期胃癌5例,进展期胃癌20例,伴有肠化生者91例.NBI对病变轮廓的显示明显优于普通内镜和靛胭脂染色(P值均=0.000).经内镜放大后,NBI对胃微血管形态的显示亦优于普通内镜和靛胭脂染色(P值均=0.000).NBI模式下萎缩性胃炎胃小凹主要表现为Ⅲ、Ⅳ、Ⅴ1型,肠化生主要表现为Ⅲ、Ⅳ、Ⅴ1、Ⅴ2型,异型增生主要表现为Ⅴ1型及Ⅳ型,胃癌主要表现为Ⅵ型.结论 NBI电子染色结合放大技术有助于提高胃癌及异型增生的活检准确率和早期胃癌检出率.     

早期胃癌及异型增生的诊断:内镜窄带成像技术与普通内镜诊断准确率的比较

目的:探讨内镜窄带成像技术(narrow-band imaging endoscopy,NBI)对早期胃癌的诊断价值.方法:97例患者分为两组,普通内镜组50例,N B I组47例,观察局灶性病变形态、色泽及微血管形态,并结合病理学检查结果分析评价两种检查方法早期胃癌的发现例数及诊断的准确性.结果:普通内镜组萎缩性胃炎伴肠化生9例,异型增生5例,早期胃癌3例.NBI组萎缩性胃炎伴肠化生11例,异型增生6例,早期胃癌5例.N B I对胃微血管形态和黏膜表面细微结构的显示更清晰,且在异型增生和早期胃癌的诊断准确率方面明显优于普通内镜(P0.05).结论:NBI有助于提高早期胃癌及异型增生的诊断率.     

窄带成像技术结合放大内镜在早期胃癌诊断中的价值研究

目的评价窄带成像技术（NBI）结合放大内镜在早期胃癌诊断中的应用价值。方法2008年3月至2008年12月经普通内镜发现存在胃黏膜可疑病灶且符合研究要求的患者共56例,行NBI结合放大内镜及靛胭脂染色检查,对NBI、靛胭脂染色诊断的胃黏膜腺管及微血管形态的清晰程度评分进行比较。内镜检查之后对所检查部位进行靶向活检,将NBI结合放大内镜及靛胭脂染色检查结果及病理检查结果进行比较。结果56例中有16例经病理诊断为早期胃癌。将NBI结合放大内镜及靛胭脂染色检查结果及病理检查结果进行统计得出：NBI结合放大内镜诊断早期胃癌的诊断符合率、敏感性、特异性、假阳性率、假阴性率分别为94．6％（53／56）、93．8％（15／16）、95．0％（38／40）、5．0％（2／40）、6．3％（1／16）;靛胭脂染色诊断早期胃癌的诊断符合率、敏感性、特异性分别为91．1％（51／56）、87．5％（14／16）、92．5％（37／40）,假阳性率、假阴性率分别为7．5％（3／40）、12．5％（2／16）;二者比较差异均无统计学意义（P均〉0．05）。NBI、靛胭脂染色诊断的胃黏膜腺管及微血管形态的清晰程度评分结果对比显示：NBI与靛胭脂染色在腺管结构显示方面无明显差别,但NBI显示微血管形态明显优于靛胭脂染色。结论NBI结合放大内镜可以提供清晰的胃黏膜血管图像,有助于早期胃癌的诊断,可提高活检检查的准确性,与靛胭脂染色联用可提高早期胃癌的诊断率。     

窄带成像放大内镜下胃小凹形态观察的临床价值

目的探讨窄带成像放大内镜(NBI)技术下胃小凹的形态分型及其临床价值。方法应用窄带成像放大内镜技术对113例患者进行检查,观察胃小凹形态,并于各不同形态处行活组织检查。结果 A、B型胃小凹主要见于慢性浅表性胃炎,C、D、E型胃小凹主要见于慢性萎缩性胃炎,D、E型胃小凹与肠上皮化生及异型增生密切相关。结论通过窄带成像放大内镜对5种胃小凹的形态观察可以推测病理组织学诊断,使镜下准确诊断胃黏膜萎缩、肠上皮化生及异型增生成为可能,以指导正确的治疗方法及内镜下随诊。     

胃黏膜萎缩、肠上皮化生及异型增生的放大内镜表现及其诊断价值

目的 确定胃黏膜萎缩、肠上皮化生及异型增生的形态学特征，探讨放大内镜结合染色对上述病变诊断的可行性和准确性。方法 应用Fujinon EG485 ZH型放大内镜对100例患者进行检查及0．5％美蓝染色，在确定A、B、C、D、E 5型基本胃小凹形态的基础上，制订放大内镜的诊断分型及放大内镜对萎缩、肠上皮化生和异型增生的判定标准，与相应部位活检所获得的417个病变组织的病理组织学检查结果进行比较分析。结果 胃黏膜萎缩主要表现为胃小凹粗大而分布稀疏，肠上皮化生表现为C、D、E型小凹形态伴美蓝着色阳性，异犁增生表现为轻度凹陷、隆起或平坦性病变伴细微结构消失、细微小凹或细微结构粗糙紊乱放大内镜对萎缩诊断的敏感性、特异性分别为95．85％和95．09％；对肠上皮化生分别为88．30％和90．83％；对异型增生分别为91．52％和94．41％，均明显高于普通内镜。结论 根据放大内镜下萎缩、肠上皮化生和异型增生的形态学特征可以使内镜对上述病变诊断的准确性明显提高。     

放大色素内镜在胃黏膜癌前病变诊断中的价值

目的:探讨放大色素内镜在胃黏膜癌前病变诊断中的应用价值.方法:应用电子放大内镜,结合美蓝染色,对180例患者的胃黏膜糜烂灶进行细微结构形态学观察,将胃黏膜小凹的形态分为:A型(圆点状)、B型(短小棒状)、C型(稀疏而粗大的线状)、D型(斑块状)、E型(绒毛状)和F型(小凹结构模糊不清、消失或伴异常增生毛细血管)6型,并与观察部位活检所得的病理组织学改变进行比较分析.结果:A,B型胃小凹主要见于正常胃黏膜,而C,D,E和F型分别见于活动性、萎缩性炎症和肠上皮化生及轻、重度异型增生的胃黏膜.E型黏膜约81.8%(99/121)为肠上皮化生.F型黏膜常提示病灶已出现不同程度的异型增生86.3%(69/80),F型黏膜伴异常增生毛细血管,89.9%出现异型增生.结论:放大色素内镜能准确识别胃小凹的形态,尤其是准确识别E和F型,有助于对肠上皮化生及异型增生等胃黏膜癌前病变的镜下诊断.     

美蓝染色对提高胃黏膜不典型病变活检阳性率的价值

目的探讨内镜下美蓝染色对胃黏膜不典型病变中早期胃癌及其癌前病变的诊断价值。方法将326例胃黏膜表现不典型的成人患者随机分成染色内镜组和普通内镜组，分别在病变部位活检送病理组织学检查。结果染色内镜组166例患者中，印例胃黏膜上皮有肠化、50例上皮呈轻度-中度不典型增生、8例为重度不典型增生、8例为早期胃癌且经手术及术后病理证实病灶仅限于黏膜层且无淋巴结转移。普通内镜组160例，病理检查结果为伴有肠上皮化生40例、轻-中度不典型增生20例、重度不典型增生2例，无早期胃癌。染色内镜组早癌及癌前病变总检出率为75．9％，其中早期胃癌检出率为12．1％，均明显高于普通内镜组。结论内镜下美蓝染色指导活检可提高胃黏膜不典型增生和早期胃癌的检出率。     

内镜窄带成像技术在诊断Barrett食管中的作用研究

目的早期发现和诊断Barrett食管（BE）中的特殊肠上皮化生（肠化）细胞等癌前病变。方法选择2006年4月至11月问29例经胃镜检查确诊为内镜BE的患者，按普通内镜、内镜窄带成像技术（NBI）、内镜靛胭脂染色加放大技术的顺序进行观察，评价各检查方法图像的清晰度；操作医生对NBI下观察到的BE黏膜腺管开口形态进行Endo分型，于改变最显著部位取活检进行病理检查，以明确特殊肠化的检出率。结果在观察鳞一柱状上皮交界的病变轮廓清晰度方面，普通内镜、染色和NBI内镜之间均有统计学差异，其中NBI最清晰，染色次之；在对BE黏膜的腺管开口形态观察中，NBI及内镜染色显著优于普通内镜；在对浅表毛细血管的观察中，NBI具有绝对优势。NBI下根据Endo分型，其Ⅳ型及V型腺管开口形态检出特殊肠化生的准确性达93％，敏感性及特异性分别达89％及95％。结论NBI作为一种新型的内镜检查系统，不仅操作简单，对病变轮廓显示清晰，更可清晰观察到BE黏膜腺管开口及浅表毛细血管结构形态，对BE食管进行靶向病理活检具有良好指导意义和临床实用价值。     

NBI放大内镜在胃黏膜糜烂鉴别诊断中的价值

目的探讨NBI放大内镜在胃黏膜糜烂鉴别诊断中的价值,以及在胃黏膜癌前病变中的诊断价值。方法应用NBI电子放大内镜,对310例患者的胃黏膜糜烂灶进行细微结构形态学观察,并与观察部位活检所得的病理组织学改变进行比较分析。结果胃黏膜糜烂灶处胃小凹形态未见到A型、B型者;365处C型中组织病理均为慢性活动性浅表性炎症;160处D型中,92.5%（148/160）为萎缩性炎症;65处E型中,86.15%（56/65）为肠上皮化生;35处F型中,91.42%（32/35）为异型增生,8.57%（3/30）为肠上皮化生。59例肠上皮化生未发现明显异常增生的毛细血管,而32例异型增生的F型黏膜表面。90.63%（29/32）呈现出不同程度异常增生的毛细血管。与病理组织学比较,NBI放大内镜观察胃黏膜糜烂小凹形态与病理组织学改变呈显著正相关（P〈0.01）。结论 NBI放大内镜在胃黏膜糜烂灶性质的判断中有很高的临床应用价值,可应用于胃黏膜癌前病变的普查。     

窄带成像技术在早期胃癌内镜诊断中的应用

目的探讨窄带成像（NBI）技术对早期胃癌的诊断价值。方法46例常规内镜发现病灶者,分别于放大内镜下行NBI及靛胭脂染色,观察黏膜腺管形态及微血管结构变化,计算清晰度评分;评价病变性质并与术后病理检查结果进行比较。结果NBI与靛胭脂染色腺管结构清晰度评分无显著差异,但微血管结构评分前者明显高于后者,P〈0．05。二者诊断早期胃癌的敏感性、特异性及与病理诊断的符合率无明显差异。结论NBI诊断早期胃癌效果确切,其优点为能清晰显示病灶微血管结构变化,从而提高诊断的精确性。     

ENDOSCOPIC SUBMUCOSAL DISSECTION FOR EARLY GASTRIC CANCER USING MAGNIFYING ENDOSCOPY WITH A COMBINATION OF NARROW BAND IMAGING AND ACETIC ACID INSTILLATION

Demarcation of early gastric cancers is sometimes unclear. Enhanced‐magnification endoscopy with acetic acid instillation and magnifying endoscopy with a narrow band imaging (NBI) system have been useful for recognition of demarcation of early gastric cancers. We report a patient with early gastric cancer who underwent a successful endoscopic submucosal dissection (ESD) by magnifying endoscopy with the combined use of NBI and acetic acid instillation. A 72‐year‐old man with early gastric cancer underwent ESD. Demarcation of the lesion was not clear, but magnifying endoscopy using the combination of NBI and acetic acid clearly revealed the demarcation. ESD was carried out after spots were marked circumferentially. We identified the positional relation between the demarcation and all markings. Resection of the lesion was on the outside of the markings. Histopathologically, the lesion was diagnosed as a well‐differentiated adenocarcinoma limited to the mucosa. The margins were carcinoma free. Magnifying endoscopy combining the use of NBI with acetic acid instillation is simple and helpful for identifying the demarcation of early gastric cancer. This method may be useful in increasing the rate of complete resection by ESD for early gastric cancer.     

Magnifying endoscopy simple diagnostic algorithm for early gastric cancer (MESDA‐G)

Gastric cancer is the third leading cause of cancer death worldwide. Early detection and accurate diagnosis of mucosal cancer is desirable in order to achieve decreased mortality; cause‐specific survival of patients with early gastric cancer is reported to exceed 95%. Endoscopy is the functional modality to detect early cancer; however, the procedure is not definitive when using conventional white‐light imaging. In contrast, magnifying narrow‐band imaging (M‐NBI), a novel endoscopic technology, is a powerful tool for characterizing gastric mucosal lesions because it can visualize the microvascular architecture and microsurface structure. To date, many reports on the diagnosis of early gastric cancer by M‐NBI, including multicenter prospective randomized studies conducted in Japan, have been published in peer‐reviewed international journals. Based on these published data, we devised a proposal for a diagnostic strategy for gastric mucosal cancer using M‐NBI to simplify the process of diagnosis and improve accuracy. Herein, we recommend a diagnostic algorithm for early gastric cancer using magnifying endoscopy.     

MAGNIFYING ENDOSCOPY WITH NARROW BAND IMAGING FOR EARLY DIFFERENTIATED GASTRIC ADENOCARCINOMA

We have been using magnifying endoscopy with narrow band imaging (NBI) to study early differentiated gastric adenocarcinomas and to assess the relationship between microvessel pattern, pit pattern and histological pattern. The magnified view of the cancerous area showed three types of pattern: (i) a mesh pattern, consisting of mesh‐like connected microvessels; (ii) a loop pattern, consisting of loop‐like microvessels that were not connected and had tubule‐like or villus‐like mucosal structures along them; and (iii) an interrupted pattern, consisting of interrupted thick or thin vessels without mucosal structures. The mesh type of microvascular pattern showed a round pit pattern in 88.9% of cases (32/36) and the loop type of microvascular pattern showed a non‐round pit pattern in 100% of cases. Among lesions that showed a mesh pattern or a loop pattern, 94.9% (56/59) were mucosal cancer and 5.1% (3/59) were submucosal cancer. However, 92.3% (12/13) of lesions that showed an interrupted pattern were submucosal differentiated adenocarcinoma and 7.7% (1/13) were mucosal differentiated adenocarcinoma. The present findings provide basic data on the characteristics of mucosal differentiated gastric adenocarcinoma revealed by magnifying endoscopy with NBI, as well as invasive changes such as submucosal invasion.     

内镜黏膜下剥离术在早期胃癌治疗中的应用进展

随着色素放大内镜、窄带成像技术、共聚焦内镜等的出现和应用,以及人们对恶性肿瘤认识的提高,越来越多的胃癌在早期阶段即被发现,其手术后5年生存率可达90%.自内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)出现以来,在消化系早期肿瘤中的治疗优势越来越明显.因其治疗效果确切、创伤小、安全性高、患者依从性好、治疗成本低、可完整切除癌灶等而备受各界关注.本文就ESD在早期胃癌(early gastric cancer,EGC)中的临床应用作一综述.     

Endoscopic features of early-stage signet-ring-cell carcinoma of the stomach

AIM: To identify the features of early signet ring cell gastric carcinoma using magnification endoscopy with narrow band imaging (NBI).METHODS: A retrospective review was conducted of 12 cases of early signet ring cell gastric carcinoma who underwent treatment in a single institution between January 2009 and April 2013. All patients had magnification endoscopy with NBI and indigo carmine contrast to closely examine the mucosal architecture, including the microvasculature and arrangement of gastric pits. Histologic examination of the final endoscopic submucosal dissection or gastrectomy specimen was performed and compared with the endoscopic findings to identify patterns specific to signet ring cell carcinoma.RESULTS: Twelve patients with early signet ring cell gastric carcinoma were identified; 75% were male, and average age was 61 years. Most of the lesions were stage T1a (83%), while the remainder were T1b (17%). The mean lesion size was 1.4 cm². On standard endoscopy, all 12 patients had a pale, flat lesion without any evidence of mucosal abnormality such as ulceration, elevation, or depression. On magnification endoscopy with NBI, all of the patients had irregularities in the glands and microvasculature consistent with early gastric cancer. In addition, all 12 patients exhibited the “stretch sign”, an elongation or expansion of the architectural structure. Histologic examination of the resected specimens demonstrated an expanded and edematous mucosal layer infiltrated with tumor cells.CONCLUSION: The “stretch sign” appears to be specific for signet ring cell carcinoma and may aid in the early diagnosis and treatment of this aggressive pathology.     

窄带成像放大内镜对胃良恶性溃疡的鉴别诊断价值

目的探讨窄带成像放大内镜对胃良恶性溃疡的鉴别诊断价值。方法对常规内镜检查诊断为胃良性溃疡者186例再行窄带成像放大内镜检查,观察溃疡边缘胃小凹及黏膜微血管改变,并于相应部位取活检做病理学检查。结果常规内镜诊断为胃良性溃疡者186例,窄带成像放大内镜检查诊断为良性溃疡174例,恶性溃疡者12例;良性溃疡胃小凹形态规则,149例（85．63％,149／174）为D型,23例（13．22％,23／174）为C型,2例（1．15％,2／174）为E型;恶性溃疡患者胃小凹形态不规则、大小不一,胃小凹基本形态均为F型（100％,12／12）。良、恶性溃疡小凹形态比较差异有显著性（P〈0．01）;76例良性溃疡患者溃疡边缘未见黏膜微血管（43．67％,76／174）,98例可见规则的血管网（56．33％,98／174）。11例恶性溃疡患者溃疡边缘可见不规则的血管（91．67％,11／12）。良恶性溃疡微血管形态比较差异有显著性（P〈0．01）。结论窄带成像放大内镜对胃良恶性溃疡的鉴别诊断有重要的参考价值。     

放大内镜窄带成像对慢性胃炎的诊断价值

目的探讨放大内镜窄带成像对慢性胃炎的诊断价值。方法110例患者接受放大内镜窄带成像检查,根据Tahara分型将观察到的胃黏膜细微结构分为0型、Ⅰ型、Ⅱ型、Ⅲ型,并与相应部位活检的病理组织学进行比较分析。结果放大内镜窄带成像下胃黏膜超微结构与胃炎的组织病理五个指标均明显相关,且与炎症的严重程度相关。从0型到Ⅰ型、Ⅱ型、Ⅲ型,反映了慢性胃炎病变发展由轻到重的一个过程。其中萎缩、肠化主要见于Ⅲ型。结论放大内镜窄带成像下胃黏膜分型与病理组织学存在密切关系,通过放大内镜窄带成像准确识别胃黏膜超微结构将有助于对萎缩、肠化生等常见胃黏膜病变的诊断。