窄带成像内镜在喉癌诊断中的应用  

Application of narrow band imaging endoscopy in the diagnosis of laryngeal cancer

作　　者：倪晓光[1] 贺舜[1] 徐震纲[2] 吕宁[3] 高黎[4] 袁峥[3] 张月明[1] 赖少清[1] 易俊林[4] 王晓雷[2] 张蕾[1] 李晓燕[1] 王贵齐[1] 

机构地区：[1]中国医学科学院肿瘤医院内镜科,北京100021 [2]中国医学科学院肿瘤医院头颈外科,北京100021 [3]中国医学科学院肿瘤医院病理科,北京100021 [4]中国医学科学院肿瘤医院放疗科,北京100021

出　　处：《中华耳鼻咽喉头颈外科杂志》2010年第2期143-147,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：基金项目：北京希望马拉松专项基金（LC2008A13）;北京市科技新星计划（2007A105）

摘　　要：目的探讨窄带成像（narrow band imaging，NBI）内镜在喉癌及其癌前病变诊断中的应用价值。方法自2008年12月至2009年7月对122例怀疑有喉癌或癌前病变的患者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部的检查。对发现的病灶依次使用白光和NBI模式进行分类和病灶性质的判断，以病理诊断作为金标准，比较两种观察模式对喉癌的诊断作用。结果122例患者中共发现了149个病灶，其中息肉16个，炎性反应7个，单纯性增生24个，轻度不典型增生17个，中度不典型增生6个，重度不典型增生6个，原位癌9个，浸润癌64个。NBI内镜对喉部病变的正确诊断率是90．6％（135／149），高于普通白光内镜的75．2％（112／149），两者比较差异有统计学意义（χ2=12．514，P〈0．001）。NBI内镜对喉癌诊断的敏感性为93．2％（68／73），高于普通白光内镜的68．5％（50／73，χ2=14．317，P〈0．001）。结论NBI内镜通过识别黏膜表面微细血管形态变化提高对喉癌诊断的敏感性和喉部病变诊断的正确率，从而增强内镜在喉癌术前诊断和术后随访中的作用。Objective To investigate the value of narrow band imaging （NBI） endoscopy in the detection of laryngeal cancer and its precursor lesions. Methods Between December 2008 and July 2009, a total of 122 consecutive patients with suspected precancerous or cancerous lesions of the larynx were enrolled in this study. High performance endoscopic system equipped with the white light mode and NBI mode was introduced in the examination of larynx. Full pharyngeal and laryngeal examination was performed first under white light endoscope and then under NBI. Each lesion was observed by NBI endoscopy and classified according to the detailed morphologic findings of epithelial microvessels. Histological results were then compared to the corresponding white light and NBI images. Results Among the 122 patients, a total of 149 lesions were detected by white light and NBI modes. The histological diagnoses of these lesions were as follows：16 laryngeal polyp, 7 laryngitis, 24 simple hyperplasia, 17 mild dysplasia, 6 moderate dysplasia, 6 severe dysplasia, 9 carcinoma in situ, 64 invasive cancer. The diagnostic accuracy by NBI for the laryngeal lesions was 90. 6% （ 135/149）, which was significantly higher than that of white light （75.2%, 112/149, χ2= 12.514, P 〈 0. 001 ）. The sensitivity of NBI and white light to detect laryngeal carcinoma was 93.2% （68/73） and 68.5% （ 50/73 ）, respectively （ χ2 = 14. 317, P 〈 0. 001 ）. Conclusions NBI endoscopy was a promising tool for the differentiation of non-malignant from malignant laryngeal lesions in vivo by detection of the morphology of mucosal capillary vessels. NBI endoscopy was easy to application in the routine pharyngolaryngeal examination with high sensitivity, and facilitated to improve the abilities of preoperative diagnosis and postoperative surveillance.

关 键 词：诊断显像 喉肿瘤 早期诊断 喉镜检查 

分 类 号：R739.65[医药卫生—肿瘤]