窄带成像放大内镜联合超声内镜对早期食管癌的诊治意义  

Significance of narrow-band imaging magnifying endoscopy combined with endoscopic ultrasonography in diagnosis and treatment of early esophageal cancer

作　　者：雷维商 张锦华 王晨晨 王明瑞 曹方 LEI Weishang;ZHANG Jinhua;WANG Chenchen;WANG Mingrui;CAO Fang(Medical College of Northwest Minzu University,Lanzhou 730030,Gansu,China;Department of Gastroenterology,Affiliated Hospital of Northwest Minzu University,Second Provincial People's Hospital,Lanzhou 730030,Gansu,China)

机构地区：[1]西北民族大学医学院,甘肃省兰州市730030 [2]西北民族大学附属医院暨甘肃省第二人民医院消化内科,甘肃省兰州市730030

出　　处：《微创医学》2020年第1期5-9,69,共6页Journal of Minimally Invasive Medicine

基　　金：西北民族大学中央高校基本科研业务费专项资金资助研究生项目(编号:Yxm2018260)。

摘　　要：目的探讨窄带成像放大内镜(NBI-ME)联合超声内镜(EUS)对早期食管癌(EEC)的诊断以及预判病变浸润深度的临床意义。方法回顾性分析高度怀疑EEC并行NBI-ME和EUS检查的44例患者的临床资料,以病理诊断为金标准,分析NBI-ME的上皮乳头内毛细血管袢(IPCL)分型对食管病变性质的诊断价值及EUS对病变浸润深度的预判作用。结果(1)NBI-ME判断EEC及癌前病变的准确率为95.45%(42/44),与活检病理一致性满意(Kappa=0.810)。(2)纳入的44例患者中39例在我院行手术切除,以术后病理分期为金标准,EUS预判病变浸润总体准确率为79.49%(31/39),与术后病理分期一致性较好(Kappa=0.626)。(3)EUS联合NBI-ME对EEC的浸润深度的总体准确率可提高至94.87%(37/39),与术后病理浸润深度一致性满意(Kappa=0.904)。(4)NBI-ME联合EUS和单纯EUS在食管病变深度判断准确率差异有统计学意义(P<0.05)。结论NBI-ME下观察食管病变部位的IPCL并进行AB分型有助于判断食管病变性质,同时联合EUS检查可以对病变浸润深度进行预判,综合评估病灶,从而为患者制订最佳的治疗方案。Objective To investigate the clinical significance of narrow-band imaging magnifying endoscopy(NBI-ME)combined with endoscopic ultrasonography(EUS)in the diagnosis of early esophageal cancer(EEC)and the prediction of lesion invasion depth.Methods The clinical data of 44 patients with highly suspected EEC and undergoing NBI-ME and EUS examination were retrospectively analyzed.With pathological diagnosis as the gold standard,the diagnosis value of NBI-ME for esophageal lesions nature by intrapapillary capillary loop(IPCL)classification and the predictive effect of EUS on the depth of lesion invasion were analyzed.Results(1)The accuracy rate of NBI-ME in identifying EEC and precancerous lesions was 95.45%(42/44),with a satisfactory consistency with biopsy pathology(Kappa=0.810).(2)Thirty-nine of 44 enrolled patients underwent surgical resection in our hospital.With the postoperative pathological stage as the gold standard,the overall accuracy rate of EUS in the prediction of lesion invasion depth was 79.49%(31/39),with a favorable consistency with postoperative pathological stage(Kappa=0.626).(3)The overall accuracy rate of EUS combined with NBI-ME for EEC invasion depth increased to 94.87%(37/39),with a satisfactory consistency with postoperative lesion invasion depth(Kappa=0.904).(4)A statistically significant difference was observed in accuracy for identifying esophageal lesion depth between NBI-ME combined with EUS and simple EUS(P<0.05).Conclusion Observing IPCL of esophageal lesions on NBI-ME and conducting AB classification are conducive to identifying esophageal lesions nature;and its combination of EUS examination can predict the depth of lesion invasion and evaluate lesions comprehensively,thus developing the optimum treatment plan for patients.

关 键 词：窄带成像放大内镜 超声内镜 早期食管癌 癌前病变 

分 类 号：R445.9[医药卫生—影像医学与核医学]