内镜窄带成像技术对早期胃癌及癌前病变的诊断价值

目的 探讨内镜窄带成像技术对早期胃癌及癌前病变的诊断价值.方法 应用普通胃镜对172例患者行常规内镜检查,采用窄带成像联合放大内镜对黏膜有可疑病变的区域进行靛胭脂染色并放大观察,分别在病变活动区域取活检标本行病理组织学检查并对其结果进行比较分析.结果 在观察病变轮廓方面,内镜窄带成像技术与染色内镜或普通内镜之间差异均有统计学意义,内镜窄带成像技术最清晰,尤其是对于局灶性浅表性病变的观察;对于胃小凹的形态观察,内镜窄带成像技术或染色内镜均优于普通内镜;在对胃黏膜微血管的观察中,内镜窄带成像技术具有绝对优势.172例中发现早期胃癌4例,重度异型增生3例,中度异型增生7例,轻度异型增生15例.可在内镜窄带成像技术模式下观察到6种胃小凹形态类型,早期胃癌主要表现为Ⅵ型,异型增生主要表现为V型及Ⅳ型.内镜窄带成像技术放大内镜下2例早期胃癌患者呈现新生或粗大血管,在其中1例显现螺旋形毛细血管.结论 内镜窄带成像技术操作简单、安全,能够较为清晰地发现癌前病变、早期胃癌的病灶,使活检病理检查阳性率明显提高,对胃癌的早期发现、早期诊断、及时治疗具有重要的临床意义.

The diagnostic value of narrow band imaging endoscopy in diagnosis of early gastric carcinoma and precancerous lesions

Objective To investigate the diagnostic value of narrow band imaging endoscopy in diagnosis of early gastric carcinoma and precancerous lesions. Methods 172 patients were recruited into this study. Routine endoscopy followed by narrow band imaging （NBI）. Chro moendoscopy combined magnifying endoscopy were performed. The gastric pits and microvasculature were also carefully observed. Results In sil houette of gastric lesion, NBI is the clearest in the above three endoscopic methods. Both mucosal pit and epithelium capillary shown much clearer by NBI than by routine endoscopy. Of 172 patients, 4 cases of early gastric carcinoma were found, 3 cases of severe dysplasia, 7 case of moderate dysplasia and 15 case of mild dysplasia according to histopathological diagnosis. Six patterns of gastric pits were summarized by NBI. Dysplasia u sually behaved as V or IV gastric pits. And VImucosal pit was suspected malignant lesion. Tumorous vessels can be seen in 3 case of early gastric carcinoma. Conclusion Endoscopic narrow hand imaging technology is simple, safe and able to discover more clear precancerous lesions and ear ly cancer lesions. The biopsy positive rate significantly increased in gastric cancer early detection. Early diagnosis and timely treatment has impor tant clinical significance.