窄带成像结合放大内镜对胃黏膜病变的定性诊断意义  

Diagnostic efficacy of magnifying endoscopy with narrow band imaging for gastric mucosal lesions

作　　者：闫红林[1] 管蕾[1] 吕文浩[2] 刘敏[2] 赵芯[2] 姚少维[2] 杨永勤[1] 单婕[1] 刘志国[2] 

机构地区：[1]西安医学院第一附属医院消化内科,西安710077 [2]第四军医大学西京消化病院

出　　处：《中华消化内镜杂志》2016年第9期609-612,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨窄带成像放大内镜（NBI-ME）对胃黏膜良恶性病变鉴别的辅助作用，及其是否有助于提高经验欠缺的内镜医生的诊断能力。方法从已发表文献中收集20例胃黏膜早期病变，每例均包括白光内镜（WLI）图片和NBI—ME图片，举办临床读片会，召集37名具有不同内镜经验的内镜医生，经简单培训后读片判断病变性质，利用投票器实时投票并分析数据。结果37名参与者均完成读片，其中14名（37．8％）内镜经验不足5年，22名（59．5％）具有NBI或放大镜操作经验。在良恶性病变的鉴别上，NBI—ME的诊断正确率优于WLI[（62．6±21．7）％比（49．8±28．7）％，P=0．005]；并且两者诊断正确率最低的3例病变完全相同，均为良性病变，包括2例局限性胃炎和1例肠上皮化生。对前7例与后7例的NBI—ME图片的阅片结果进行对比分析后发现，两者间参与者群体诊断正确率差异无统计学意义[（55．8±26．3）％比（69．0±27．1）％，P=0．377]，剔除22名具有NBI—ME操作经验者后两者问差异亦无统计学意义[（56．5±23．2）％比（67．4±25．3）％，P=0．356]。结论NBI—ME有助于内镜下对病变良恶性的判断，对内镜经验欠缺的内镜医生也有帮助，经简单培训后即可进行一般病例的判断，但对于萎缩性胃炎和肠上皮化生的排除尚有待于进一步提高。Objective To study the diagnostic value of magnifying endoscopy with narrow band ima- ging（NBI-ME） for gastric neoplastic lesion and its role in developing diagnostic skills of less experienced en- doscopists. Methods White light images and magnifying endoscopic images with narrow band imaging of 20 cases of early gastric lesions were collected from published literature. Thirty-seven endoscopists with various experiences were invited to a diagnosis workshop to study these cases. After a short training course of diagno- sis, real time vote was performed and data were analyzed. Results All thirty-seven endoscopists finished the diagnosis workshop. Fourteen endoscopists （37.8%） had work experience of less than five years, and 22 （ 59. 5% ） had experience in either magnifying endoscopy or narrow band imaging. The diagnostic accuracy of NBI-ME was significantly higher than that of white light imaging [ （62. 6±21.7）% VS（49. 8±28.7）% ,P= 0. 005 ] , but was consistent in the 3 cases with lowest diagnostic accuracy, which were all benign including two cases of localized gastritis and one metaplasia. Comparison between the diagnostic accuracy rates of first and last seven cases showed there was no statistical difference [ （ 55.8±26. 3 ） % VS （ 69.0± 27. 1 ） %, P = 0. 377 ], neither was there when 22 experienced endoscopists in NBI-ME were excluded [ （ 56. 5± 23.2 ） % VS（67. 4±25.3）% ,P= 0. 356]. Conclusion Magnifying endoscopy with narrow band imaging is superior to white light imaging in diagnosis of early gastric mucosal lesions. It is also helpful to improve diagnostic skills of less experienced endoscopists. But it may be of lower diagnostic accuracy for such benign lesion as gastric atrophy and intraepithelial metaplasia.

关 键 词：放大内镜检查 窄带成像技术 早期胃癌 培训 

分 类 号：R735.2[医药卫生—肿瘤] R573[医药卫生—临床医学]