放大内镜诊断早期食管癌及其癌前病变的临床应用

目的探讨放大内镜在早期食管癌及其癌前病变诊断中的临床应用价值。方法常规应用普通内镜检查,发现可疑病变后,通过手动变焦放大内镜对可疑病变部位的上皮乳头内毛细血管袢（IPCL）进行形态学观察,同时进行IPCL形态分型。在可疑部位的多个点取病理活检,以病理诊断结果为标准,将普通内镜病变类型与放大内镜IPCL形态分型进行对比分析。结果早期食管癌IPCL形态异常,分型均为Ⅳ型（100%）,食管上皮中度异型增生的IPCL形态以Ⅱ、Ⅲ型为主87.5%,轻度异型增生的IPCL形态以Ⅱ型为主77.78%,食管炎患者的IPCL形态以Ⅱ型为主91.66%。IPCL形态异常愈明显、其细胞异型愈严重。结论放大内镜IPCL形态学分型对于早期食管癌及其癌前病变的诊断与病理检查结果有较高符合率,优于普通内镜检查。放大内镜IPCL形态学分型有助于提高早期食管癌及其癌前病变诊断的准确率。

Clinical applications of magnifying endoscopy in the diagnosis of early esophageal cancer and precancerous lesions

Objective To investigate the clinical application value of the magnifying endoscopy in the early diagnosis of esophageal cancer and precancerous lesions. Methods The conventional endoscopy was applicated to discover the suspicious lesion. The morphological observations and typing patterns of the epithelial papillary capillary loop （intrapapillary capillary loop, IPCL） in the suspicious lesion were carried out by zoom magnifying endoscopy. The biopsy was done from a number of points of the suspicious lesion for pathologic diagnosis. According to tile pathologic diagnosis, the general types of the suspicious lesion under endoscopy were compared with that of IPCL under the magnifying endoscopy. Results The IPCL configurations of early esophageal cancer were abnormal and their types were type Ⅳ （100%）. The morphological form of the IPCL of the esophageal epithelial moderate dysplasia was mainly type Ⅱ and Ⅲ （87.5%）. The morphological form of the IPCL of the mild dysplasia was mainly in the form of type Ⅱ（77.78%）. The IPCL configurations of the esophagitis were mainly type Ⅱ （91.66%）. More obvious abnormal the morphological form of IPCL and more serious their cell heteromorphism. Conclusion The morphological typing of the IPCL under magnifying endoscopy in early diagnosis of the esophageal cancer and precancerous lesions is mostly consistent with the pathological findings. The diagnostic accuracy under the magnifying endoscopy is better than that under the ordinary endoscope. The morphological typing of the IPCL under the magnifying endoscopy could be used to improve the early diagnostic accuracy of the esophageal cancer and precancerous lesions.