色素内镜、窄带成像内镜对大肠平坦型病变检出的对比性研究  

A Comparative Study on the Detection of Flat Lesion with Chromoendoscopy and Narrow Band Imaging

作　　者：朱敏[1] 李明阳[1] 王志强[1] 

机构地区：[1]解放军总医院,北京100853

出　　处：《现代生物医学进展》2010年第24期4683-4686,共4页Progress in Modern Biomedicine

摘　　要：目的:探讨色素内镜(CE)、窄带成像内镜(NBI)对大肠平坦型病变的检出及相关因素。方法:对2010年4月至6月来我院国际医学中心的276例患者行结肠镜检查,262例患者入选。先行常规白光模式插镜至回盲部,应用NBI模式退镜观察,检出平坦型病变后记录病变特征(包括数量、部位、形态、大小),然后再在常规白光模式下插镜至回盲部,应用0.25%靛胭脂染色后行色素内镜退镜观察,检出平坦型病变后记录病变特征,最后于病变活检。比较CE和NBI对平坦型病变的检出并分析相关因素。结果:262例患者中,共计检出病变198个,其中平坦型病变69个,检出率为34.8%。NBI检出平坦型病变51个(73.9%);CE检出平坦型病变69个(100%)(P<0.05)。NBI漏诊了18个平坦型病变,漏诊率为26.1%。NBI检出的平坦型病变平均大小为8.7±2.6mm,CE检出的平坦型病变平均大小为4.5±2.1mm(P<0.05)。NBI检出<5mm的平坦型病变5个(7.2%),CE检出<5mm的平坦型病变19个(27.5%)(P<0.05)。NBI检出的IIc型平坦型病变13个(18.8%),CE检出的IIc型平坦型病变25个(36.2%)(P<0.05)。NBI检出炎症/增生性平坦型病变29个(42.0%),CE检出炎症/增生性平坦型病变37个(53.6%)(P<0.05)。结论:在大肠平坦型病变的检出中,NBI内镜存在一定的漏诊率,漏诊病变主要是IIc型病变和炎症/增生性病变。色素内镜在微小型病变(<5mm)、IIc型病变的检出中,比NBI内镜更有优势。Objective： To discuss the effect of chromoendoscopy（CE）and narrow band imaging（NBI） on the detection of flat lesion and the relative factors involved.Methods： Totally 262 patients were picked from 276 patients via colonoscopy from April to June,2010.The endoscope was first inserted to ileocecal junction in routine white light mode and observation was made in NBI mode.Where flat lesions were found,records of the characteristics（including number,position,pattern and size） of the pathological changes were made accordingly.The routine white light mode endoscopy to the ileocecal junction was run once again and spray with 0.25% indigo carmine was applied before chromoendoscopy.Characteristics of the pathological changes were recorded and biopsy was performed.Result： Totally 198 lesions（including 69 flat lesions）were detected in the 262 patients.The detection rate was 34.8%.Among the flat le-sions,51（73.9%） were detected by NBI and 69（100%）by CE（P0.05）.The average size of the flat lesions detected by NBI and CE is 8.7＋2.6mm and 4.5＋2.1mm（P0.05） respectively.For flat lesions with diameter 5mm,there are 5（7.2%）and 19（27.5%）cases that were detected by NBI and CE respectively.There are 13（18.8%）flat lesions（IIc）detected by NBI and 25（36.2%）by CE.Among all the 18 missed cases by NBI,61.1% were adenomatous lesions.Conclusions： There is a certain proportion of missing in the detection of flat lesions of large intestine.CE has a higher detection rate than NBI,especially in the detection of small lesions,depressed lesions（IIc）and,which makes CE more preferable than NBI.

关 键 词：结肠镜 色素内镜 窄带成像内镜 平坦型病变 检出 

分 类 号：R573[医药卫生—消化系统]