色素内镜在电子结肠镜中应用价值研究

目的:结肠镜下应用色染料或色素可增强病变的定位和特征,有利于发现早期结肠肿瘤,且对于内镜下治疗有帮助,采用普通和放大内镜结合染色对于结病变的发现和性质诊断与病理结果进行对照,评价色素内镜的临床价值。方法:对2007年1月至7月在内镜中心拟作内镜下息肉切除的病例81例,117个息肉,分别采用普通结肠镜和放大镜下结合结合0·4%靛胭脂染色采用按工藤分类法进行分类,预测其病理类型,对于不能分类者再采用0·2%甲酚紫染色进行分类,然后行息肉电切后全部送病理活检,将病理结果与内镜下预测对比,分析色素内镜的临床价值。结果:普通电子镜采用靛兰胭脂红染色后所有息肉清晰显示其形态和边界,明显优于染色前。放大肠镜靛胭脂染色对64例87个息肉按工藤分类法进行分类,17例30个息肉靛兰胭脂红染色无法分类,采用0·2%的甲酚紫染色分类,其中Ⅰ型11个,Ⅱ型27个,Ⅲ型46个,Ⅳ型25个,Ⅴ型8例。与病理结果对比,息肉表面腺管开口为Ⅰ、Ⅱ型的的38例病变中全部为增生性息肉,Ⅲ型46个中ⅢL1型33个,管状腺瘤28个,管状绒毛腺瘤5个,ⅢL2型13个,管状腺瘤11个,管状绒毛腺瘤2个,本组未发现现Ⅲs型息肉。Ⅳ型25个中绒毛管状腺瘤15个,绒毛腺瘤8个,灶性癌变2个。Ⅴ型8例,Ⅴ1型3个,ⅤN型5均为腺癌。普通电子肠镜结合色素内镜发现息肉的能力优于普通电子肠镜,对于表面腺管开口的识别靛胭脂染色对ⅢL型,Ⅳ型,Ⅴ型腺管开口有较好的识别能力,明显优于普通电子肠镜,但是对于Ⅰ型、Ⅱ型的鉴别能力差。染色结合放大镜能较好地区分各型,腺管开口的类型对于肿瘤与非肿瘤的鉴别与病理类型有良好的一致性。结论:①普通肠镜结合色素内镜能提高发现结肠息肉敏感性,对于早其肿瘤的诊断与鉴别诊断有价值。②放大肠镜结合色素内镜能清晰显示病变表面结构和腺管开口,对于肿瘤与非肿瘤的鉴别诊断接近病理诊断,对于早期癌的发现有很高的价值,值得更进一步研究与推广应用。

Clinical Applicalion of the Value of Chromoendoscopy in Colonoscopy

Objective:Chromoendoscopy can improve localisation,characterisation,or diagnosis of lesions.It enables the endoscopist to make a diagnosis and/or to direct biopsies based on a specific reaction or enhancement of surface morphology.The aim of the present study is to compare the value of chromoendoscopy for the discovery and differentiation diagnosis of the colonic lesions.Methods:Using indigo or cresyl violet as the pigments in total 117 colorectal polyps from 81 patients were analyzed the surface according to the pit pattern classification by either magnifying and non-magnifying chromoendoscopy.Histologic analysis was performed on all lesions.Results:Using indigo as pigments under non-magnifying chromoendoscopy the border of the lesions is much clearer than conventional colonoscopy.Using the Kudo classification of mucosal patterns,chromoendoscopy with magnification resulted very high value in the differentiation of neoplastic vs.non-neoplastic lesions and in the discovery of early colonic cancer.Conclusion:Non-magnifying chromoendoscopy is more sensitivity in the discovery colonic lesions than conventional colonoscopy.Chromoendoscopy combination with magnifying endoscopy is a valuable tool for the differentiation of neoplastic from non-neoplastic colorectal polyps in vivo.