色素内镜与窄带成像放大内镜诊断幽门螺杆菌根除后早期胃癌边界的对比分析  

A comparative study of chromoendoscopy and magnifying endoscopy with narrow-band imaging in the diagnosis of boundary of early gastric cancer after Helicobacter pylori eradication

作　　者：杨小云[1] 洪依萍 钱璐珈 胡益冰 王聪 丁进 YANG Xiaoyun;HONG Yiping;QIAN Lujia;HU Yibing;WANG Cong;DING Jin(Department of Gastroenterology,Affiliated Jinhua Hospital,Zhejiang University School of Medicine,Jinhua 321000,Zhejiang,China;Department of Pathology,Affiliated Jinhua Hospital,Zhejiang University School of Medicine,Jinhua 321000,Zhejiang,China)

机构地区：[1]浙江大学医学院附属金华医院消化内科,浙江金华321000 [2]浙江大学医学院附属金华医院病理科,浙江金华321000

出　　处：《中国现代医生》2023年第31期4-8,21,共6页China Modern Doctor

基　　金：浙江省基础公益研究计划(LGF19H160022);金华市科技计划项目(2018-3-001f)。

摘　　要：目的探讨色素内镜(chromoendoscopy,CE)与窄带成像放大内镜(magnifying endoscopy with narrow-band imaging,ME-NBI)评估幽门螺杆菌(Helicobacter pylori,Hp)根除后早期胃癌边界的准确性及其影响因素。方法选取2019年1月至2021年12月于浙江大学医学院附属金华医院确诊为Hp根除后早期胃癌并行内镜黏膜下剥离术治疗的71例患者为研究对象,根据随机数字表法将其分为口侧CE组(n=35)和口侧ME-NBI组(n=36)。比较CE与ME-NBI评估Hp根除后早期胃癌边界的准确率,通过单因素和多因素Logistic回归分析探究CE与ME-NBI错误评估肿瘤边界的相关因素。结果ME-NBI评估Hp根除后早期胃癌边界的准确率高于CE(P<0.05);ME-NBI诊断浅表凹陷型Hp根除后早期胃癌边界的准确率高于CE(P<0.05)。单因素分析显示,ME-NBI错误评估肿瘤边界与非肿瘤上皮覆盖率相关(P<0.05);CE错误评估肿瘤边界与组织学类型、黏液表型、非肿瘤上皮覆盖率相关(P<0.05)。多因素Logistic回归分析显示,未分化型早癌、非肿瘤上皮覆盖率>10%、胃肠混合表型均是CE错误评估Hp根除后早期胃癌边界的独立危险因素(P<0.05)。结论ME-NBI评估Hp根除后早期胃癌边界的准确性优于CE。未分化型早癌、非肿瘤上皮覆盖率>10%、胃肠混合表型是CE错误评估Hp根除后早期胃癌边界的独立危险因素。Objective To investigate the accuracy and relative factors of chromoendoscopy(CE)and magnifying endoscopy with narrow-band imaging(ME-NBI)in evaluating boundary of early gastric cancer after Helicobacter pylori(Hp)eradication.Methods In this study,71 patients diagnosed with early gastric cancer after Hp eradication and treated with endoscopic submucosal dissection at Affiliated Jinhua Hospital,Zhejiang University School of Medicine from January 2019 to December 2021 were selected.They were divided into oral CE group(n=35)and oral ME-NBI group(n=36)according to random number method.We compared the rate of accurate evaluation of CE and ME-NBI for boundary of early gastric cancer after Hp eradication,and analyzed the risk factors related to inaccurate evaluation using univariate and multivariate Logistic analysis.Results The accuracy of ME-NBI in evaluation boundary of early gastric cancer after Hp eradication was higher than that of CE(P<0.05).The accuracy of ME-NBI in diagnosing the boundary of early gastric cancer after Hp eradication of superficial concave type was higher than that of CE(P<0.05).Univariate analysis revealed that non-neoplastic epithelium coverage was associated with inaccurate margin evaluation by ME-NBI(P<0.05).Inaccurate margin evaluation by CE was correlated with histological type,mucous phenotype and non-neoplastic epithelial coverage(P<0.05).Multivariate Logistic analysis indicated that undifferentiated early cancer,non-neoplastic epithelial coverage>10%,mixed gastrointestinal phenotype were independent risk factors for inaccurate margin evaluation of early gastric cancer after Hp eradication by CE.Conclusion The accuracy of ME-NBI in evaluating boundary of early gastric cancer after Hp eradication was better than that of CE.Undifferentiated early cancer,non-neoplastic epithelial coverage>10%and mixed gastrointestinal phenotype were independent risk factors for inaccurate margin evaluation of early gastric cancer after Hp eradication by CE.

关 键 词：色素内镜 窄带成像放大内镜 幽门螺杆菌 早期胃癌 边界 

分 类 号：R573[医药卫生—消化系统]