碘染色、窄带成像及超声内镜在早期食管鳞癌及其癌前病变内镜黏膜下剥离术前评估价值  

Value of iodine staining, narrow-band imaging and ultrasound in preoperative evaluation of ESD in early esophageal squamous cell carcinoma and its precancerous lesions

作　　者：王茂生 刘晓波 郜元军 WANG Mao-sheng;LIU Xiao-bo;GAO Yuan-jun(Department of Gastroenterology,Taihe Hospital,Hubei University of Medicine,442000Taihe,Hubei,China)

机构地区：[1]湖北医药学院附属医院&十堰市太和医院消化内科,湖北十堰442000

出　　处：《临床消化病杂志》2022年第5期321-324,共4页Chinese Journal of Clinical Gastroenterology

基　　金：湖北省教育厅中青年项目(No:Q20102112)。

摘　　要：[目的]研究碘染色、窄带成像(NBI)内镜及超声内镜(EUS)在早期食管鳞癌及癌前病变内镜黏膜下剥离术(ESD)前评估的价值。[方法]收集行ESD治疗的早期食管鳞癌及其癌前病变患者的临床病理资料,以术后病检结果作为病变诊断金标准,比较碘染色、NBI内镜对早期食管癌及癌前病变的诊断率及病变范围判断有无差异;比较放大内镜结合NBI内镜技术(ME-NBI)、EUS对病灶浸润深度判断的准确性。[结果]NBI内镜对早期食管鳞癌的诊断率与碘染色内镜相同,对其癌前病变诊断率低于碘染色内镜,差异无统计学意义(P>0.05);本研究中NBI内镜和碘染色内镜下早期食管鳞癌及其癌前病变范围分别为(2.88±1.40)、(3.22±1.65)cm,部分病变碘染色内镜下显示范围更大,差异具有统计学意义(P<0.05);ME-NBI对早期食管鳞癌及其癌前病变浸润深度判断的准确度高于EUS,差异具有统计学意义(P<0.05)。[结论]建议ESD前对非甲状腺功能亢进、过敏体质、颈部食管疾病患者行全食管碘染色内镜联合ME-NBI检查,以判断病变范围和浸润深度;单独运用EUS判断病变深度有一定的局限性。[Objective]To investigate the application of iodine staining, narrow-band imaging(NBI) and endoscopic ultrasonographys(EUD) in the preoperative period of endoscopic submucosal dissection(ESD) in early esophageal squamous cell carcinoma and precancerous lesions.[Methods]The clinicopathological data of early esophageal squamous cell carcinoma and its precancerous lesions treated with ESD were collected.Postoperative tissue pathological examination results were used as the gold standard for lesion diagnosis.The diagnostic rate and lesion range of early esophageal carcinoma and precancerous lesions were compared with iodine staining and NBI endoscopy to determine whether there was any difference.The accuracy of ME-NBI and EUS in judging the depth of lesion invasion was compared.[Results]The diagnostic rate of NBI endoscopy for early esophageal squamous cell carcinoma was the same as that of iodine staining endoscopy, but the diagnostic rate of precancerous lesions was lower than that of iodine staining endoscopy, and the difference was not statistically significant(P> 0.05).In this study, the range of early esophageal squamous cell carcinoma and its precancerous lesions under NBI endoscopy and iodine staining was(2.88±1.40) and(3.22±1.65) cm, respectively, and the range of iodine staining under endoscopy for some lesions was larger, with statistical significance(P<0.05).The accuracy of ME-NBI in judging the depth of infiltration of early esophageal squamous cell carcinoma and its precancerous lesions was higher than that of endoscopic ultrasonography, and the difference was statistically significant(P<0.05).[Conclusion]It is recommended that patients with non-hyperthyroidism, allergic constitution and cervical esophageal disease should undergo total esophageal iodine staining combined with ME-NBI examination before ESD operation to determine the lesion range and depth of invasion.Endoscopic ultrasonography alone has some limitations in judging lesion depth.

关 键 词：食管肿瘤 碘染色 窄带成像 腔内超声检查 内镜黏膜下剥离术 

分 类 号：R735.1[医药卫生—肿瘤]