放大色素内镜联合窄带成像对炎症性肠病相关异型增生和结直肠癌的诊断价值  

Magnifying chromoendoscopy with narrow band imaging for dysplasia and colorectal cancer in inflammatory bowel disease

作　　者：吴东[1] 周炜洵[2] 杨红[1] 李玥[1] 李骥[1] 李景南[1] 钱家鸣[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院消化内科,北京100730 [2]中国医学科学院北京协和医学院北京协和医院病理科,北京100730

出　　处：《中华消化内镜杂志》2017年第3期163-168,共6页Chinese Journal of Digestive Endoscopy

基　　金：首都卫生发展科研专项课题（2011-4001-01）

摘　　要：目的探讨放大内镜联合靛胭脂染色和窄带成像技术（NBI），对炎症性肠病（IBD）相关的异型增生和结直肠癌的诊断价值。方法在长病程IBD患者结肠镜检查中，先后应用白光、NBI和靛胭脂染色放大观察，对可疑病变实施靶向活检或切除，以病理诊断为金标准评估该方法对IBD的筛查效果。结果共纳入长病程IBD患者45例，其中16例（17处病变）检出异型增生或癌，包括低级别异型增生12例（26．7％），高级别异型增生4例（8．9％），结肠癌1例（2．2％）。靶向活检的阳性率为13．2％（17／129）。NBI国际结直肠内镜（NICE）分型和工藤分型的检出率分别为81．3％（13／16）和75．0％（12／16），二者联合的检出率为100％。在合并异型增生和结肠癌的患者中，随着年龄增长（P=0．027）和病程延长（P=0．013），病变恶性程度有加重的趋势。高级别异型增生和结肠癌的病变直径[（2．5±1．4）cm]大于低级别异型增生[（0．6±0．4）cm]（P=0．003）。结论对于IBD相关异型增生和结直肠癌，放大色素内镜联合NBI可有效检出病变并判断其性质，为正确治疗奠定基础。Objective To study the diagnostic value of magnifying chromoendoscopy combined with narrow band imaging （NBI） for screening inflammatory bowel disease （IBD） and colorectal cancer（CRC）. Methods In colonoscopic examinations of long-term IBD patients, magnifying colonoscopy was used to make the consecutive observation with white light, NBI, and indigo carmine spraying. Targeted biopsies or endoscopic resections were performed for histological diagnosis as the golden standard of this study. Results Sixteen cases （ 17 lesions） with dysplasia or colorectal cancer in 45 long-term IBD patients were detected, including 12 （26.7%） cases of low-grade dysplasia （LGD）, 4 （8.9%） cases of high-grade dysplasia （HGD）, and 1 （2. 2%） case of CRC. Targeted biopsy yielded a positive rate of 13.2% （17/129）. Detection rates of NICE and Kudo classification were 81.3%（13/16） and 75. 0%（ 12/16）, respectively, and were 100. 0% when combined together. Age （ P = 0. 027） and prolonged disease course （ P = 0. 013 ） were associated with advanced histology in those with dysplasia or CRC. Lesions of HGD and CRC have larger diameters （2.5 ± 1.4 cm） than LGD （0.6±0.4 cm） （P = 0.003）. Conclusion Magnifying chromoendoscopy with NBI is effective to detect and differentiate colitis-related neoplastic lesions, thus allowing rational therapeutic plans.

关 键 词：炎性肠疾病 结直肠肿瘤 内窥镜检查 胃肠道 窄带成像 放大 染色 

分 类 号：R574[医药卫生—消化系统] R735.3[医药卫生—内科学]