内镜窄带成像技术在诊断肠上皮化生中的应用  

The clinical value of narrow band imaging endoscopy in diagnosing intestinal metaplasia

作　　者：刘振鹏[1] 梁秀兰[1] 贾安平[1] 黄建勋[1] 庞恩桥[1] 李春英[1] 

机构地区：[1]广西壮族自治区柳州市柳铁中心医院,545007

出　　处：《山西医药杂志（下半月）》2013年第3期250-252,共3页Shanxi Medical Journal

基　　金：广西柳州市应用技术研究与开发计划(201003073726)

摘　　要：目的确定内镜窄带成像技术(NBI)下胃黏膜肠上皮化生(IM)的形态学特征,并结合组织病理学探讨NBI诊断IM的可行性和准确性。方法应用NBI对40例患者行常规内镜检查,对黏膜有可疑病变的区域行窄带成像联合放大内镜(NBI-ME)观察,在黏膜绒毛状改变并血管消失区域取活检标本行病理组织学检查并对其结果进行分析。结果 40例患者接受了NBI检查,NBI内镜下可以清晰地显示胃小凹和黏膜血管改变,胃黏膜结构呈绒毛状改变,成为IM的重要特征。经病理组织学诊断28例患者有IM。28例确诊IM的患者中,49块活检标本病理证实IM,其中45块内镜诊断为IM。NBI诊断IM的敏感度为92%,特异度为86%。同期普通内镜检查的40例患者,病理活检证实23例,31块活检标本病理证实IM,其中10块内镜诊断为IM。普通内镜对IM诊断的阳性预测值为88%,阴性预测值为71%,敏感度为32%,特异度为96%。NBI下在绒毛状改变黏膜区活检可明显提高IM的检出率(P<0.05)。结论 NBI-ME有助于内镜直视下对绒毛状改变并血管消失区域的靶向活检,从而提高胃黏膜IM的检出率,对胃癌的早期发现、早期诊断、及时治疗具有重要的临床意义。Objective To investigate the morphologic features of gastric intestinal metaplasia（IM）using nar- row band imaging（NBI）endoscopy and its feasibility and accuracy for diagnosis of IM combined with histopatholo- gy. Methods The endoscopic examination was performed on 40 patients and suspected lesions associated with IM was further observed by NBI combined with magnifying endoscopy. The biopsy specimens were obtained from re- gions containing villous mucosa for pathological examination. Those results were analyzed. Results In 40 patients examined with NBI, villous patterns were visualized in lesions with IM. IM was pathologically confirmed in 28 pa- tients. Of which, 49 biopsy specimens were diagnosed pathologically as intestinal metaplasia, and 45 specimens were diagnosed by NBI. The sensitivity and specificity was 92~/00 and 86%. In 40 patients examined with routine endoscopy,IM was pathologically confirmed in 23 patients. Of which, 31 biopsy specimens were diagnosed patho- logically as intestinal metaplasia, 10 specimens were diagnosed by routine endoscopy. The sensitivity and specifici- ty was 32%, and 96%. The detective rate of IM could be increased if biopsy specimen was obtained from villous region with help of NBI endoscopy（P〈0. 05）. Conclusion It has been demonstrated that NBI combined with magnifying endoscopy may improve the diagnosis of IM by clearly observing microvasculature and targeted-biopsy in villous region,which is helpful in early diagnosis of gastric cancer.

关 键 词：胃黏膜 化生 肠黏膜 内镜检查 

分 类 号：R735.2[医药卫生—肿瘤]