电子喉镜窄带成像技术在诊断喉癌中的价值

发布时间：2019-05-11 13:48

【摘要】：目的：探讨窄带成像（narrow band imaging，NBI）内镜在诊断喉癌中的应用价值。方法：研究中病例选取2013年6月至2014年3月因主观症状在我科接受电子喉镜检查的患者，患者主诉为咽喉部异物感或不适感，痰中带血，伴或不伴有声嘶，病史包括长期吸烟史。对104例怀疑有喉癌或癌前病变的患者分别选用具有普通白光和NBI两种观察模式的电子内镜进行咽喉各个部位的检查。在发现可疑病灶后先后使用白光和NBI模式观察并进行分类，操作医师对NBI下观察到的上皮内乳头样毛细血管袢（intraepithelial papillarycapillary loop，IPCL）进行分型，对病灶性质做初步的判断，以病理诊断作为金标准，比较IPCL形态特点及其与组织学分型的对应关系，并比较两种检查方法的灵敏度、特异性、阳性预测值及阴性预测值。结果：（1）NBI模式下观察，可以清晰的显示黏膜表层的微血管形态。当黏膜表层发生病变时，尤其是新生物形成时，IPCL形态就会发生改变。恶性病变的NBI内镜特点是病灶区出现列排不规则的紧密的棕色斑点，并且病变的边界能够较白光显示的更加清晰。斑点越大越清晰，分布排列越不规则，恶性的可能性越大。随着病变的进展，病灶区毛细血管可呈现为扭曲的条索样，如蝌蚪形、蚯蚓形、蛇形。重度不典型增生的表现和原位癌表现相似，以较大的棕色斑点为主要特点，而轻度和中度不典型增生的黏膜病灶区虽可见斑点，但相对明显缩小，排列较为稀疏、尚规则。单纯性增生因病灶表面多为角化的上皮或增生的鳞状上皮覆盖，表现为白色伪膜覆盖，很难看到斑点。炎性反则表现为黏膜表层的毛细血管扩张。息肉的黏膜表层的血管表现与正常黏膜的相似。（2）104例怀疑喉癌或癌前病变的患者发现病灶117个，其中单纯性增生16个，轻度不典型增生15个，中度不典型增生7个，息肉12个，，炎性反应3个，重度不典型增生6，原位癌9个，浸润癌49个。（3）NBI内镜对喉癌诊断的灵敏度为91.4%，而普通白光内镜的灵敏度为74.1%。二者之间的差异有统计学意义（χ2=6.04, p0.05）。NBI内镜对喉癌诊断的阴性预测值为91.9%，普通白光内镜的78.6%，两者间差异有统计学意义（χ2=4.53, p0.05）。结论：窄带成像技术（NBI）作为一种新兴的内镜下成像诊断技术，其操作简单，能清晰地显现病变的轮廓及黏膜表层及黏膜下层微血管的各种形态变化，并对初步判断病理类型有一定的价值。NBI内镜对喉癌诊断的灵敏度及阴性预测值高于普通白光内镜检查方法，使之可以成为提高肿瘤检出率及鉴别肿瘤病变性质的有效手段。
[Abstract]:Objective: to evaluate the value of narrow band imaging (narrow band imaging,NBI) endoscopy in the diagnosis of laryngeal carcinoma. Methods: from June 2013 to March 2014, patients who underwent electronic laryngoscope examination in our department due to subjective symptoms were selected. The patients complained of foreign body feeling or discomfort in pharynx and larynx, blood in sputum, with or without hoarseness. Medical history includes a history of long-term smoking. Electronic endoscopy with common white light and NBI was used to examine all parts of pharynx and larynx in 104 patients with suspected laryngeal carcinoma or precancerous lesions. After discovery of suspicious lesions, white light and NBI patterns were used to observe and classify the lesions, and doctors were used to classify the (intraepithelial papillarycapillary loop,IPCL observed in the intraepithelial papilla-like capillary loop under NBI, and to make a preliminary judgement on the nature of the lesions. Using pathological diagnosis as gold standard, the morphological characteristics of IPCL and its corresponding relationship with histologic types were compared, and the sensitivity, specificity, positive predictive value and negative predictive value of the two methods were compared. Results: (1) the morphology of microvessels on the surface of mucous membrane could be clearly displayed by NBI mode. When lesions occur on the surface of the mucous membrane, especially when new organisms are formed, the morphology of IPCL changes. NBI endoscopy of malignant lesions is characterized by irregular and dense brown spots in the lesion area, and the boundary of the lesion can be more clearly displayed than that of white light. The larger the spots, the clearer the distribution and arrangement, and the greater the possibility of malignancy. With the development of the lesion, the capillaries in the lesion area can appear as twisted strips, such as tadpole, earthworm and serpentine. The manifestations of severe atypical hyperplasia were similar to those of carcinoma in situ, characterized by large brown spots, while those in mild and moderate atypical hyperplasia were relatively small, sparsely arranged and regular. Simple hyperplasia is covered with white pseudomembrane because the surface of the lesion is mostly covered by keratinized epithelial or hyperplastic scaly epithelial, so it is difficult to see spots. The inflammatory reaction showed telangiectasia on the surface of the mucous membrane. The vascular appearance on the surface of polyp is similar to that of normal mucosa. (2) 117 lesions were found in 104 patients with suspected laryngeal or precancerous lesions, including 16 simple hyperplasia, 15 mild atypical hyperplasia, 7 moderate atypical hyperplasia, 12 polyps, 3 inflammatory reactions and 6 severe atypical hyperplasia. There were 9 carcinoma in situ and 49 invasive carcinoma. (3) the sensitivity of NBI endoscopy in the diagnosis of laryngeal carcinoma was 91.4%, while that of conventional white light endoscopy was 74.1%. The negative predictive value of NBI endoscopy in the diagnosis of laryngeal carcinoma was 91.9%, and that of ordinary white light endoscopy was 78.6%. There was significant difference between the two groups (蠂 2, 4.53, p 0.05). The negative predictive value of NBI endoscopy in laryngeal carcinoma was 91.9% and 78.6% of that in common white light endoscopy (蠂 2, P 0.05). Conclusion: narrow band imaging (NBI) is a new technique for endoscopic imaging diagnosis. It is easy to operate and can clearly show the contour of the lesion and various morphological changes of the superficial and submucosal microvessels. The sensitivity and negative predictive value of NBI endoscopy in the diagnosis of laryngeal carcinoma are higher than that of ordinary white light endoscopy, which makes it an effective method to improve the detection rate of tumor and differentiate the nature of tumor lesions.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.65

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