放大内镜下微血管改变对早期食管癌的诊断价值  

Microvasculature change in the diagnosis of early esophageal carcinoma using magnifying endoscopy

作　　者：季锐[1] 卢雪峰[1] 付金栋 雒燕[1] 王玉娟[1] 涂立锐[1] 

机构地区：[1]山东大学齐鲁医院消化内科,济南250012 [2]山东日照人民医院

出　　处：《中华消化内镜杂志》2007年第6期415-418,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的研究放大染色内镜对早期食管癌的检出率,探讨黏膜微血管图像改变与组织学诊断的关系。方法收集214例常规内镜观察下有食管黏膜粗糙、糜烂、斑块、颜色异常、微隆起或凹陷等改变的患者及16例健康志愿者,应用2%Lugol 液染色后进行放大内镜观察,根据内镜下上皮乳头内毛细血管袢改变将放大内镜下黏膜象分为4型。对病变区取活检送病理检查,将内镜结果与组织病理诊断对照研究后进行统计学分析。结果 80.4%(90/112)食管炎患者符合Ⅱ型表现,85.7%(12/14)早期食管癌患者符合Ⅲ型和Ⅳ型改变。早期食管癌组与正常组比较(x^2=27.32,P<0.05)和食管炎组比较(x^2=50.37,P<O.05)差异均有统计学意义;黏膜癌与黏膜下癌组比较差异亦有统计学意义(x^2=14.00,P<0.05)。结论微血管图像改变与组织诊断密切相关,放大内镜配合染色可提高早期食管癌的检出率,且有助于判断癌变浸润深度。Objective To study the detection rate of early esophageal carcinoma using magnifying endoscopy, and to evaluate the relationship between the imaging patterns of microvasculature change and histological diagnosis. Methods Two hundred and fourteen patients with esophageal mucosa roughness, erosion, plaque, abnormal color and indentation in conventional endoscopy and 16 healthy volunteers were enrolled. The magnifying endoscopy images were graded as four patterns by intraepithelial papillary capillary loop （IPCL） changes after iodine dyeing. The biopsies underwent pathologic evaluation. The comparison between the imaging patterns of endoscopy and histological diagnosiswas was evaluated. Results 80.4% （90/ 112）esophagitis was type 2, and 85.7% （12/14）early esophageal carcinoma was type 3 and type 4. The difference was significant between early esophageal carcinoma and normal mucosa （Х^2 = 27. 32, P 〈 0.05 ）, and between early esophageal carcinoma and esophagitis （Х^2 = 50. 37, P 〈 0. 05 ）, there is also a significant difference between mucosal carcinoma and submucosa carcinoma（ Х^2= 14. 00, P 〈 0. 05 ）. Conclusion The imaging patterns of microvasculature change under magnifying endoscopy can raise the diagnostic rate of early esophageal carcinoma.

关 键 词：食管肿瘤 诊断 微血管 放大内镜检查 

分 类 号：R735.1[医药卫生—肿瘤]