食管病变上皮乳头内毛细血管袢的形态与病理组织的关系探讨

目的探讨食管病变上皮乳头内毛细血管袢的形态与病理组织的关系。方法137例经常规内镜观察食管黏膜有粗糙、糜烂、颜色异常、微隆起等病变及30例食管黏膜正常的志愿者，在窄带成像放大内镜下观察病变部位上皮乳头内毛细血管袢的形态，并在其引导下对病变区行活组织病理检查，将放大内镜下毛细血管袢的形态结果与组织病理诊断对照研究后进行统计学分析。结果137例食管病变在窄带成像放大内镜引导下对病变区行活组织病理检查确诊鳞癌27例，其中早期食管癌15例；高级别瘤变2l例；低级别瘤变23例；食管炎66例。食管癌组85．18％（23／27）为Ⅳ型IPCL、14．82％（4／27）为Ⅲ型IPCL，高级别瘤变组76．19％（16／21）为Ⅲ型IPCL、23．81％（5／21）为Ⅳ型IPCL，低级别瘤变组56．52％（13／23）为Ⅲ型IPCL、43．48％（10／23）为Ⅱ型IPCL，食管炎组90．91％（60／66）为Ⅱ型IPCL、9．09％（6／66）为I型IPCL，正常对照组100％IPCL分型为I型。食管癌、高级别瘤变的IPCL与食管炎、正常对照组的IPCL比较，差异有统计学意义（P〈0．05）。结论根据食管黏膜IPCL的形态类型可以初步判定食管病变的良、恶性，窄带成像放大内镜可应用于食管癌的普查。

Study the relationship between the imaging patterns of microvasculature change and histological diagnosis

Objective To study the relationship between the imaging patterns of microvasculature change and histological diagnosis.Methods One hundred and thirty-seven patients with esophageal mucosa roughness,erosion,plaque,abnormal color and indentation in conventional endoscopy and thirty healthy volunteers were enrolled in this study.The magnifying endoscopy images were graded as four patterns by intraepithelial papillary capillary loop(IPCL) changes by NBI .The biopsies underwent pathologic evaluation.The imaging patterns of endoscopy and histological diagnosis were compared and statistically analyzed.Results 137 patients were diagnosed by narrow-band imaging system with magnifying endoscopy combined miniprobe sonography.Among these patients,27 cases were pathologically diagnosed as squamous cancer including 15 cases of early esophageal cancer,21 cases were high grade intraepithelial neoplasia,23 cases were low grade intraepithelial neoplasia,66 cases were chronic inflammation.100% esophageal carcinoma and high grade intraepithelial neoplasia were Ⅳ,Ⅲ type IPCL,56.52% low grade intraepithelial neoplasia was Ⅲ type IPCL,43.48% wasⅡtype IPCL,90.91% esophagitis wasⅡtype IPCL.100% esophageal normal mucosa wasⅠtype IPCL.The difference was significant among esophageal carcinoma,high grade intraepithelial neoplasia and esophagitis,esophageal normal mucosa (P＜0.05).Conclusions The imaging patterns of microvasculature change under NBI magnifying endoscopy were crucial in the diagnosis and identification of benign and malignant of esophageal disease.