窄带成像内镜用于声带白斑诊断的意义  

The Application of Narrow Band Imaging Laryngoscopy in the Diagnosis of Vocal Cord Leukoplakia

作　　者：闫静[1] 杜小滢[1] 李娜[1] 孔德敏[1] 侯瑾[1] 任晓勇[1] Yan Jing;Du Xiaoying;Li Na;Kong Demin;Hou Jin;Ren Xiaoyong(Department of Otorhinolaryngology,Second Affiliated Hospital of Medical College, Xi’an Jiaotong University,Xi’an,710004,China)

机构地区：[1]西安交通大学第二附属医院耳鼻咽喉头颈外科病院,西安710004

出　　处：《听力学及言语疾病杂志》2018年第6期628-631,共4页Journal of Audiology and Speech Pathology

摘　　要：目的探讨窄带成像(narrow band imaging,NBI)内镜在声带白斑诊断中的临床应用价值。方法以91例临床诊断为声带白斑的患者为研究对象,均为男性,年龄37～83岁,平均57.10±11.02岁;所有患者术前均进行白光和NBI两种观察模式的电子喉镜检查,记录声带病变的内镜诊断,术后切除的病变组织均送病理检查,以病理检查结果为金标准,比较两种观察模式下内镜对声带白斑不同病理类型诊断的准确率。结果 91例患者中双侧声带前中部病变62例(68.13%),单侧声带前中部病变29例(31.87%);普通白光内镜诊断良性病变38例,癌前病变38例,恶性病变15例;NBI内镜诊断良性病变33例,癌前病变42例,恶性病变16例。病理检查显示黏膜慢性炎症伴鳞状上皮增生33例(36.26%),轻、中、重度不典型增生共39例(42.86%),原位癌14例(15.38%),浸润癌5例(5.49%);与病理结果比较,白光模式下内镜诊断准确率为79.12%(72/91),NBI模式下内镜诊断准确率为90.11%(82/91),前者低于后者,差异有统计学意义(P<0.05);5例浸润癌患者,术前白光模式及NBI模式内镜下均诊断准确。结论 NBI内镜在观察细微病变方面优于白光内镜,有利于提高声带白斑不同病理类型诊断的准确性。Objective To investigate the clinical application of narrow band imaging(NBI)laryngoscopy in the diagnosis of vocal cord leukoplakia.Methods The clinical data of 91 male patients aged from 37 to 83 years old,diagnosed with vocal cord leukoplakia were collected from January 2016 to March 2017.All patients underwent electronic laryngoscope with normal white light and NBI modes before surgery.The laryngoscopic diagnosis in both of the two modes were compared to post-operation rathological diagnosis,which was model-affected as golden standards.The diagnostic accuracy of these two modes was analysed.Results The situs of the leukoplakia were anterior and middle vocal folds in 62 patients(68.13%),and unilateral anterior vocal cords in 29 patients(31.87%).Pathological examination showed that there were 33 cases of chronic mucosal inflammation accompanied with squamous epithelial hyperplasia(36.26%),39 cases of atypical hyperplasia(42.86%),14 cases of carcinoma in situ(15.38%),invasive carcinoma in 5 cases(5.49%).In the normal white light mode,38 cases were diagnosed as benign lesions,38 cases as precancerous lesions,and 15 cases as malignant lesions.In comparison,in the NBI mode,33 cases were diagnosed as benign lesions,42 as precancerous lesions and 16 as malignant lesions.Compared with the pathological results,the diagnostic positive rate of normal white light was 79.12%,and of NBI mode was 90.11%.The difference were statistically significant.As for 5 cases of invasive carcinoma,white light mode and NBI mode were diagnosed correctly.Conclusion NBI endoscopy is superior to normal white light in the early assessments of minor lesions,which can enhance the recognition of atypical hyperplasia and improve the diagnostic accuracy of different pathological types of vocal cord leukoplakia,furthmore effectively guide the physician in making the treatment plan.

关 键 词：窄带成像 内镜 声带白斑 

分 类 号：R767.4[医药卫生—耳鼻咽喉科]