内镜窄带成像与染色技术诊断大肠肿瘤的对比研究

目的通过窄带成像技术（NBI）和染色放大方法对大肠新生性病变进行观察，比较这两种技术对大肠肿瘤及非肿瘤性病变的鉴别诊断精度差异。方法2006年6月至9月间，共302例年龄在加至80岁之间的患者进行了NBI肠镜检查，其中98例入选。内镜插入至回盲部，退镜时分别采用常规模式、NBI模式观察，发现病变后，分别用NBI模式及染色放大方法进行血管分型及腺管开口分型，然后行病理检查进行评价比较。结果在98例患者发现新生性病变147个，其中常规内镜下发现的病变有90．5％（133／147），采用NBI发现病变有98．6％（145／147），差异有统计学意义（P〈0．01），漏诊的主要为平坦型病变。NBI观察对肿瘤性或非肿瘤的判断符合率为91．8％，染色内镜为82．3％（P〈0.01）。结论NBI技术观察黏膜表面变化，判断肿瘤或非肿瘤病变的符合率比普通内镜和染色内镜高，敏感性强；操作转换简单易行，尤其有利于平坦型病变的发现及诊断。

A comparative study of Narrow-Band Imaging, and chromoendoscopy in the diagnosis of colorectal neoplasia

Objective To compare the diagnostic efficacies of Narrow-Band Imaging ( NBI) in differentiating neoplastic from non-neoplastic colorectal lesions with diagnostic efficacies of conventional colonoscopy and chromoendoscopy. Methods Three hundred and two patients, age from 20 to 80, were examined by NBI in the Nan fang Hospital from June to September in 2006. Ninety eight patients were enrolled in this study. They were observed with conventional colonoscopy, and, under NBI and chromoendoscopy. Lesions were resected or biopsy for histopathological analysis. Sensitivity, specificity, and diagnostic accuracy of each endoscopic modality were assessed by reference to histopathology. Results One hundred and forty seven colorectal lesions were found in 98 patients. 133 lesions were founded under the conventional colonoscopy , while 14 flat lesions were missed. Only 2 flat lesion were missed under NBI. The detection rate of conventional colonoscopy and NBI was 90. 5% and 98. 6% respectively (P <0. 01). The accuracy of NBI and chromoendoscopy was 91. 8% and 82. 3% respectively ( P < 0. 01). The diagnostic accuracy of NBI with high magnification was significantly higher than that of conventional colonoscopy and was comparable to that of chromoendoscopy. Conclusion NBI were capable in distinguishing neoplastic from non-neoplastic colorectal lesions and the diagnostic accuracy of NBI was better than that of conventional colonoscopy and equivalent to that of chromoendoscopy. It is an effective technology to reduce the time of examination.