结直肠无蒂锯齿状腺瘤/息肉在白光内镜和窄带成像模式下的形态特征  

Morphological features of colorectal sessile serrated adenoma/polyp under white light endoscopy and narrow band imaging

作　　者：田甜 崔静[1] 胡桂明[2] 赵治国 曹智博 李浩 Tian Tian;Jing Cui;Gui-ming Hu;Zhi-guo Zhao;Zhi-bo Cao;Hao Li(Department of Digestive Diseases, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou,Henan 450000, China;Department of Pathology, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China;Department of Digestive Diseases, Zhengzhou Yihe Hospital Affiliated to Henan University, Zhengzhou, Henan 450000, China)

机构地区：[1]郑州大学第二附属医院消化内科,河南郑州450000 [2]郑州大学第二附属医院病理科,河南郑州450000 [3]河南大学附属郑州颐和医院消化内科,河南郑州450000

出　　处：《中国内镜杂志》2017年第12期66-72,共7页China Journal of Endoscopy

摘　　要：目的探讨结直肠无蒂锯齿状腺瘤/息肉(SSA/P)在白光内镜(WLE)和窄带成像(NBI)模式下的形态特征及与增生性息肉(HP)的鉴别要点。方法回顾性分析2014年1月-2017年3月郑州大学第二附属医院内镜室检出的SSA/P的形态特征,与HP按大小配对进行比较。结果纳入41例患者的50枚SSA/P,43例患者的50枚HP。SSA/P位于右半结肠者多于HP,但差异无统计学意义(16枚vs 14枚,P>0.05)。SSA/P中呈Ⅰs型者11枚,Ⅱa型21枚,Ⅱb型16枚,LST型2枚,HP中呈Ⅰs型者17枚,Ⅱa型25枚,Ⅱb型8枚,差异无统计学意义(P>0.05);SSA/P中表面富于黏液者多于HP(37枚vs 11枚,P<0.05)。NBI模式:SSA/P具有红色黏液帽、边界模糊、形态不规则、隐窝内黑点、积云样表面、Ⅱ-O型腺管开口和表面微血管网的比例均高于HP(P<0.05)。在SSA/P与HP的鉴别预测中:隐窝内黑点(OR^:14.2;95%CI:5.8~34.7)的灵敏度、特异度、准确性分别是:80.0%、78.0%、79.0%,灵敏度较高;Ⅱ-O型腺管开口(OR^:56.0;95%CI:17.7~177.6)的灵敏度、特异度、准确性分别是:70.0%、96.0%、83.0%,特异度较高;红色黏液帽(OR^:9.3;95%CI:3.8~22.8)的灵敏度、特异度和准确性分别是:64.0%、84.0%、74.0%,特异度较高;积云样表面(OR^:16.9;95%CI:5.7~50.7)的灵敏度、特异度和准确性分别是:52.0%、94.0%、73.0%,特异度较高,灵敏度较低。联合隐窝内黑点和Ⅱ-O型腺管开口与其他形态特征对SSA/P进行诊断预测能提高诊断预测的灵敏度和准确性。结论研究证实在NBI模式下SSA/P相比HP具有独特的形态特征。NBI模式下对SSA/P形态特征进行观察,可达到鉴别SSA/P和HP的目的。隐窝内黑点和Ⅱ-O型腺管开口在诊断预测SSA/P时分别具有较高的灵敏度和特异度,推荐在结肠镜检查时可联合两者与其他形态特征对SSA/P进行诊断预测,以达到内镜下筛查诊断SSA/P的目的。Objective To investigate the morphological features of colorectal sessile serrated adenoma/polyp(SSA/P)by white light endoscopy(WLE)and narrow band imaging(NBI).Methods A retrospective analysis was made on the morphological characteristics of SSA/P from January2014to March2017,and compared with HP.Results There were50cases of SSA/P from41patients and50cases of HP from43patients.SSA/P located in the right colon was more than HP,but the difference was no statistical significance(16cases vs14cases,P>0.05).SSA/P have11cases of Type Is,21cases of Type IIa,16cases of Type IIb,2cases of Type LST,HP have17cases of Type Is,25cases of Type IIa,8cases of Type IIb,there was no significant difference(P>0.05);SSA/P has more mucus than HP(37cases vs11cases,P<0.05).In NBI:The proportion of SSA/P with a red mucus cap,indistinctive borders,irregular shape,black dots inside the crypts,Cloud-like surface,Type II-O pit pattern and varicose microvascular vessels were higher than that of HP(P<0.05).In the differential prediction of SSA/P and HP:Black dots inside the crypts(OR^:14.2;95%CI:5.8～34.7)with higher sensitivity,the sensitivity,specificity and accuracy respectively were80.0%,78.0%,79.0%;Type II-O pit pattern(OR^:56.0;95%CI:17.7~177.6)with higher specificity,the sensitivity,specificity and accuracy respectively were:70.0%,96.0%,83.0%;Red mucus cap(OR^:9.3;95%CI:3.8~22.8)with high specificity,the sensitivity,specificity and accuracy respectively were64.0%,80.0%,74.0%;Cloud-like surface(OR^:16.9;95%CI:5.7~50.7)with high specificity and low sensitivity,the sensitivity,specificity and accuracy respectively were:52.0%,94.0%,73.0%.Combining the black dots inside the crypts and Type II-O pit pattern with other endoscopic features of SSA/P could improve the sensitivity and the accuracy in diagnosis prediction.Conclusion The study has confirmed that SSA/P has unique endoscopic features compared with HP in NBI mode.Observing the morphological characteristics of SSA/P with NBI could achieve the purpose of identifying SSA/P and HP.The bla

关 键 词：无蒂锯齿状腺瘤/息肉 增生性息肉 锯齿状腺瘤 窄带成像模式 

分 类 号：R574.6[医药卫生—消化系统]