窄带成像技术结合放大内镜对早期食管癌及癌前病变的诊断价值

发布时间：2018-04-28 16:03

本文选题：窄带成像技术 + 上皮乳头内毛细血管袢　；参考：《山西医科大学》2015年硕士论文

【摘要】：目的:探讨窄带成像技术结合放大内镜对早期食管癌及癌前病变的诊断价值。方法:分别运用普通白光内镜、NBI、染色内镜对发现食管黏膜异常者进行观察,评价三种方法对早期食管癌及癌前病变的检出率;对三种方法清晰度进行分析;在NBI下联合放大内镜观察鳞状上皮乳头内毛细血管袢(IPCL)的改变并进行分级,于疑似病变最明显处行活检并对其进行病理组织学检查;确诊为早期食管癌及癌前病变的患者,行内镜黏膜切除术/内镜黏膜下切除术,进行术前术后病理组织学检查结果进行对比;比较NBI分级、碘染色分级与病理的关系。结果:(1)普通白光内镜、NBI与染色内镜的符合率分别为53.44%、83.21%、87.02%。数据显示:NBI及碘染色与病理的符合率明显高于普通白光内镜。(2)NBI诊断食管上段早癌及癌前疾病具有显著的优势。(3)NBI与染色内镜观察病变边界清晰度比较无差异(P=0.465)。NBI下A8模式以黏膜腺管开口为观察对象,B8模式以微细血管为观察对象,均优于染色内镜。(4)高级别上皮内瘤变和早期癌主要表现为NBI I级有56处、NBI II、III级有11处,阴性有30处。低级别上皮内瘤变主要表现为NBI I级有8处、NBI II、III级有31处,阴性有8处。统计结果相关分析Spearman=0.656,P=0.000。一致性Kappa=0.535,P=0.000。HGIN和早期癌主要表现为NBI碘染色I级有60处、NBI II、III级有7处,阴性有4处。LGIN主要表现为NBI I级有7处、NBI II、III级有35处,阴性有5处。统计结果相关分析Spearman=0.733,P=0.000。一致性Kappa=0.689,P=0.000。数据表明:NBI分级、碘染色分级在全程食管下与病理具有相关性。(5)食管炎患者IPCL分型以I、II型为主,I-II型占84.62%;LGIN患者IPCL以II、III型为主,II、III型占63.83%;HGIN患者IPCL分型以IV型为主,IV型占71.19%;早期食管癌患者以V1、V2、V3为主,V1、V2、V3占100%。数据表明:IPCL形态分型与病理一致。结论:窄带成像技术(NBI)是一种通过特殊的光谱变化能够使黏膜表面的微血管及黏膜表面形态得到强化的光学图像增强技术。通过放大内镜可以观察IPCL形态,反映组织不典型增生及小病灶的组织学特点并可指导内镜下对病变的靶向活检。故NBI联合放大内镜对早癌及癌前病变诊断有临床应用价值,值得进一步推广研究。
[Abstract]:Objective: to evaluate the diagnostic value of narrowband imaging combined with magnifying endoscopy for early esophageal carcinoma and precancerous lesions. Methods: normal white light endoscopy and staining endoscopy were used to observe the abnormal esophageal mucosa, to evaluate the detectable rate of early esophageal carcinoma and precancerous lesions, to analyze the definition of the three methods. The changes of IPCLs in squamous epithelial papilla were observed under NBI combined with magnifying endoscopy, and the most obvious lesions were examined by biopsy and histopathology, and the patients with early esophageal cancer and precancerous lesions were diagnosed as early esophageal cancer and precancerous lesions. Endoscopic mucosal resection / endoscopic submucosal resection were performed to compare the results of preoperative and postoperative histopathology, and to compare the relationship between NBI grade, iodine staining grade and pathology. Results the coincidence rates of NBI and staining endoscopy were 53.44 and 83.21, respectively. The data showed that the coincidence rate between the pathological changes and the proportion of 1% NBI and iodine staining was significantly higher than that of the normal white light endoscopy in the diagnosis of upper esophageal early carcinoma and precancerous diseases. There was no significant difference in the definition of the lesion boundary between the upper esophageal carcinoma and the staining endoscopy. The model was based on the opening of mucosal ducts, and the B8 model was used to observe the fine blood vessels. The main manifestations of high grade intraepithelial neoplasia and early carcinoma were 56 cases of NBI grade I, 11 cases of grade III of NBI II and 30 cases of negative. In the low grade intraepithelial neoplasia, there were 8 cases of NBI I grade and 31 cases of NBI II III grade, and 8 cases were negative. The correlation analysis of the statistical results showed that Spearmania was 0.656Pu 0.000. The results showed that there were 60 NBI iodine staining grade I and 7 NBI-III grade, 4 negative. LGIN mainly showed NBI I grade 7, NBI-III grade 35 and negative grade 5. The results were as follows: Kappa: 0.535A: P0. 000.HGIN and early carcinomas showed that there were 60 cases of NBI iodine staining grade I and 7 cases of NBIIII grade III, and 7 cases of negative staining, and 7 cases of NBI grade I and 35 cases of NBI-III grade negative. The correlation analysis of the statistical results showed that Spearmania was 0.733Pu 0.000. The consistency of Kappaa is 0.689 and 0.000. The data show that the: NBI rating, The IPCL classification of patients with esophagitis was mainly I-II and 84.62LGIN. The main type of IPCL in patients with esophagitis was type IV (63.833.83%) and the group of patients with early esophageal carcinoma was V1V2V3 (V1V2V3) and V1V2V3 (100%). The data showed that the morphologic classification of WIPCL was consistent with pathology. Conclusion: narrow band imaging (NBI) is an optical image enhancement technique which can enhance the microvessel and morphology of mucosal surface through special spectral changes. The morphology of IPCL can be observed by magnifying endoscopy, which can reflect the histological characteristics of atypical hyperplasia and small lesions, and can guide the target biopsy of lesions under endoscope. Therefore, NBI combined with magnifying endoscopy has clinical value in the diagnosis of early cancer and precancerous lesions.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.1

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