NBI内镜在结肠息肉癌变中的诊断价值及结肠息肉癌变影响因素研究  

Value of NBI endoscopy in the diagnosis of colon polyp carcinogenesis and the study of influencing factors of colon polyp carcinogenesis

作　　者：鲍正华[1] 马启刚[2] 唐伟[1] BAO Zheng-hua;MA Qi-gang;TANG Wei(Department of Gastroenterology,Lu'an Hospital of Traditional Chinese Medicine,Lu'an Anhui 237006,China;Department of Anesthesiology,Lu'an Hospital of Traditional Chinese Medicine,Lu'an Anhui 237006,China)

机构地区：[1]六安市中医院消化内科,安徽六安237006 [2]六安市中医院麻醉科,安徽六安237006

出　　处：《临床和实验医学杂志》2022年第5期487-490,共4页Journal of Clinical and Experimental Medicine

基　　金：国家中医药管理局中医药标准化项目[编号:SATCM-2015-BZ(087)]。

摘　　要：目的探讨内镜下窄带成像技术(NBI)内镜在诊断结肠息肉癌变的诊断价值及结肠息肉癌变的影响因素。方法回顾性选取2018年8月至2020年5月六安市中医院收治的结肠息肉样病变患者105例(结肠息肉样病变组织128个)的临床资料,以病理组织学检查为确诊结肠息肉癌的金标准,按照结肠息肉是否癌变分为肿瘤性病变组(n=60)与非肿瘤性病变组(n=45),均给予NBI内镜和常规白光内镜检查。观察不同检查方法对结肠息肉癌变的阳性预测值、阴性预测值、确诊率、敏感性、特异性,且分析影响结肠息肉癌变的因素。结果在128个结肠息肉样病变组织中,经病理组织学检查确诊为结肠息肉癌变共69个,占比为53.91%,非肿瘤性病变共59个,占比为46.09%。NBI内镜和常规白光内镜检查对Ⅰ型、Ⅱ型、Ⅲ型、Ⅳ型/混合型、开口模糊型腺管开口的诊断比率差异有统计学意义(P<0.05)。128个结肠息肉样病变组织经NBI内镜检查后阳性预测值为92.42%,阴性预测值为83.88%;与金标准差异无统计学意义(P>0.05)。经常规白光内镜检查后阳性预测值为80.79%,阴性预测值为64.47%,低于金标准,差异有统计学意义(P<0.05)。NBI内镜诊断结肠息肉癌变的敏感性、准确率为88.41%、88.28%,均高于常规白光内镜(60.87%、71.09%),差异有统计学意义(P<0.05);而特异性与常规白光内镜差异无统计学意义(P>0.05)。单因素分析显示,年龄、息肉数目、息肉大小、息肉形态与结肠息肉癌变有关(P<0.05)。经二元Logistic回归分析显示,年龄、息肉数目、息肉大小、息肉形态是影响结肠息肉癌变的危险因素(P<0.05)。结论NBI内镜通过观察肠息肉样病变的黏膜表面腺管开口,为临床诊断结肠息肉癌变提供客观依据,其诊断效能高于常规白光内镜。年龄、息肉数目、息肉大小、息肉形态是影响结肠息肉癌变的危险因素。Objective To explore the value of narrow-band imaging(NBI)endoscopy in the diagnosis of colonic polyp carcinogenesis and the influencing factors of colonic polyp carcinogenesis.Methods The clinical data of 105 patients with colon polypoid lesions(128 colonic polypoid lesion tissues)admitted to Lu'an Hospital of Traditional Chinese Medicine from August 2018 to May 2020 were retrospectively selected,and histopathological examination was used as the gold standard for the diagnosis of colon polyp cancer.Whether polyps become cancerous is divided into neoplastic lesion group(n=60)and non-neoplastic lesion group(n=45).Both NBI endoscopy and conventional white light endoscopy were given to observe the positive predictive value of different examination methods for colon polyp canceration,Negative predictive value,diagnosis rate,sensitivity,specificity,and the factors affecting colon polyp carcinogenesis were analyzed.Results Among 128 colonic polypoid lesions,69 were diagnosed as colonic polyp cancer by histopathological examination,accounting for 53.91%,and 59 were non-neoplastic lesions,accounting for 46.09%.NBI endoscopy and conventional white light endoscopy had significant differences in the diagnosis rate of typeⅠ,typeⅡ,typeⅢ,typeⅣ/mixed type,and fuzzy opening type duct openings(P<0.05).The positive predictive value of 128 colonic polypoid lesions after NBI endoscopy was 92.42%,and the negative predictive value was 83.88%,there was no statistically significant difference from the gold standard(P>0.05).After routine white light endoscopy,the positive predictive value was 80.79%,and the negative predictive value was 64.47%,it was lower than the gold standard,the difference was statistically significant(P<0.05).The sensitivity and accuracy of NBI endoscopy in diagnosing colon polyp canceration were 88.41%,88.28%,which were higher than those of conventional white light endoscopy(60.87%,71.09%),the differences were statistically significant(P<0.05);while the specificity was not significantly different from that

关 键 词：结肠息肉 癌变 NBI内镜 诊断价值 影响因素 

分 类 号：R735.35[医药卫生—肿瘤]