内镜窄带成像筛查早期胃癌、癌前病变的应用分析  

Screening early gastric carcinoma and precancerous lesions with narrowband endoscopic imaging

作　　者：范洪波[1] 邹文[1] 宋铭祥[1] 李林辉[1] 杨燕敏[1] 赵云凰[1] 赵炳[1] 

机构地区：[1]云南省玉溪市人民医院消化内科,云南玉溪653100

出　　处：《中国医师杂志》2009年第7期910-913,共4页Journal of Chinese Physician

摘　　要：目的观察内镜窄带成像技术（NBI）筛查癌前病变、早期胃癌的特点。方法对74例患者进行了研究，同一病例自身对照，在无痛麻醉状态下，先进镜至十二指肠降段，用普通模式退镜观察至贲门，记录发现病灶，低倍放大病灶（1．4、1．6、1．8倍）。再次进镜至十二指肠降段，用NBI模式退镜观察至贲门记录所发现病灶，对病灶低倍放大（1．4、1．6、1．8倍），可疑病灶行活检。把图片转化为Word文档，按需放大图片。结果慢性胃炎以A型、AB型较多；轻度肠化、轻度不典型增生：以BC、AB较多，总体分析是以含C型的混合型居多；中度不典型增生：CD型、AC型；重度不典型增生：CD型、D型；早期胃癌（浅表凹陷）：BC型＋不规则粗A型；进展期胃癌：CD型、D型、C型；幽门螺杆菌感染：A型、B型较多；隆起型、凹陷型病灶普通内镜、NBI下病灶没有漏诊。但对于平坦型病灶普通内镜易漏诊，NBI较少漏诊。结论NBI具有操作简单、安全，能够较为清晰发现癌前病变、早期胃癌的病灶。使活检病理检查阳性率明显提高，从而提高癌前病变、早期胃癌、平坦型病灶的诊断率。Objective To observe the characteristic of precancerous lesions and early gastric carcinoma with narrow belt imaging technology. Methods The 74 patients were enrolled in this study. The same case was used as self-control. The operation was made in painless under anesthesia. When the mirror was advanced to the duodenal descending segment, an ordinary microscope mode was used and the mirror was back to Mallory, the lesions found were recorded, the image was zoomed in with low-fold and observed （ 1.4,1.6,1.8 times）. Suspicious lesions were collected and biopsies were made. Results Chronic gastritis could be commonly found in type A and AB. Mild intestinalization and mild atypical hyperplasia could be commonly found in mixed type holding type C, type BC and AB. Moderate atypical hyperplasia could be found in type CD and AC, and heavy atypical hyperplasia in type CD and D. Early gastric cancers （superficial depressed） were seen in type BC and irregular thick type A. Advanced gastric cancers were in type CD, D and C. Helicobaeter pylori infection were common in type A and B. Protruded type, sunken type were not easily missed with common endoscopic and NBI. But for ordinary focus of infection, it was easily missed with common endoscopic, while less with NBI . Conclusion NBI is a simple and safe method, which can be used to find precancerous lesions and early gastric cancer lesions more easily. It will enhance the diagnosis rate of precancerous lesions and early gastric cancer as positive rate of biopsy was markedly improved.

关 键 词：内窥镜检查 胃肿瘤/诊断 诊断显像 

分 类 号：R735.2[医药卫生—肿瘤] R445[医药卫生—临床医学]