超声内镜结合LCI/BLI-ME判断根除幽门螺杆菌后早期胃癌浸润深度的研究  

EUS Combined with LCI/BLI-ME in Determination of Infiltration Depth of Early Gastric Cancer after HelicobacterpyloriEradication

作　　者：周晓黎[1] 舒磊[1] 杨林[1] 杨健[1] 廖艳[1] 时昭红[1] Zhou Xiaoli;Shu Lei;Yang Lin(Department of Gastroenterology,Wuhan No.1Hospital,Wuhan 430022,China)

机构地区：[1]武汉市第一医院消化内科,武汉430022

出　　处：《华中科技大学学报（医学版）》2024年第1期39-44,51,共7页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：武汉市医学科研面上项目(No.WX19A06);湖北省卫生健康委联合基金项目(No.WJ2019H321)。

摘　　要：目的 探讨超声内镜结合联动成像技术/蓝激光成像技术-放大内镜(LCI/BLI-ME)对根除幽门螺杆菌后早期胃癌浸润深度的判断及其准确性的影响因素,评价其临床应用价值。方法 收集2017年10月至2023年6月武汉市第一医院收治的91例根除幽门螺杆菌后早期胃癌患者的临床资料,以病理学检查结果作为判断标准,总结根除幽门螺杆菌后胃黏膜及早期胃癌在内镜下的特征表现,分析超声内镜结合LCI/BLI-ME对根除幽门螺杆菌后早期胃癌浸润深度的判断准确性及影响其判断准确性的相关因素。诊断效能的统计学描述采用灵敏度、特异度、准确度表示;采用χ^(2)检验和多因素Logistic回归分析对超声内镜的诊断结果与术后病理学检查结果进行比较。结果 超声内镜结合LCI/BLI-ME对根除幽门螺杆菌后早期胃癌浸润深度判断的总体准确率77.08%,对uT1a期及uT1b期的判断准确率分别为82.86%和61.53%。分期不足12例,占17.14%;分期过度10例,占38.46%。对黏膜层病变判断的诊断敏感度85.29%,诊断特异度57.14%,阳性预测值82.86%,阴性预测值61.5%。单因素和多因素Logistic回归分析结果表明,病变最大径、组织分化类型是影响判断准确性的因素,而病变部位、病灶形态与判断准确性无相关性。病灶越大,对浸润深度判断的准确性越低;组织分化程度越低,对浸润深度判断的准确性越低。结论 超声内镜结合LCI/BLI-ME对根除幽门螺杆菌后早期胃癌uT1a期的浸润深度判断具有较好的临床应用价值,病灶大小及组织分化程度对判断的准确性有影响。Objective To explore the value of endoscopic ultrasonography combined with linked color imaging/blue laser imaging technology combined with magnifying endoscopy(LCI/BLI-ME)in determining the depth of infiltration in early gastric cancer after eradication of Helicobacter pylori(H.pylori),as well as the influencing factors affecting the accuracy of the judgment,so as to explore its clinical application value.Methods Clinical data of 91patients with early gastric cancer after H.pylori eradication were collected from October 2017to June 2023in Wuhan No.1Hospital.Based on the pathological diagnosis,the endoscopic manifestations of gastric mucosa and early gastric cancer after eradication of H.pylori were summarized.The accuracy of endoscopic ultrasonography combined with LCI/BLI-ME in determining the infiltrating depth of early gastric cancer and the related factors affecting the accuracy were evaluated.Sensitivity,specificity,and accuracy were used to indicate the effectiveness of endoscopic diagnosis.Chi-square test was used to compare the difference between endoscopic diagnosis and pathological diagnosis.Logistic regression analysis was used to determine the factors affecting the diagnostic accuracy of endoscopy.Results The overall accuracy of endoscopic ultrasonography combined with LCI/BLI-ME in determining the infiltration depth of early gastric cancer after H.pylorieradication was 77.08%,and the accuracies of uT1aand uT1bstages were 82.86%and 61.53%,respectively.There were 12under-diagnosed cases(17.14%)and 10over-diagnosed cases(38.46%).The sensitivity,specificity,positive predictive value and negative predictive value of endoscopic ultrasonography combined with LCI/BLI-ME in the diagnosis of mucosal lesions were 85.29%,57.14%,82.86%and 61.5%,respectively.The results of univariate and multivariate logistic regression analysis showed that the maximum diameter of the lesion and the degree of tissue differentiation were the factors affecting the diagnostic accuracy,but not the location and shape of the lesion.The

关 键 词：早期胃癌 超声内镜 联动成像技术 蓝激光成像技术 

分 类 号：R735.2[医药卫生—肿瘤]