电子喉镜结合窄带成像内镜及其分型在声带白斑诊断中的应用  

Application of electronic laryngoscope combined with narrow band imaging endoscope and its classification in the diagnosis of vocal cord leukoplakia

作　　者：林川耀[1] 张思思 徐玉芹 周宇 高下[1] LIN Chuanyao;ZHANG Sisi;XU Yuqin;ZHOU Yu;GAO Xia(Department of Otolaryngology Head and Neck Surgery,Nanjing Drum Tower Hospital,Nanjing Drum Tower Hospital Clinical College,Nanjing Medical University,Jiangsu Provincial Medical Key Discipline,Research Institute of Otolaryngology,Nanjing,210008,China)

机构地区：[1]南京医科大学鼓楼临床医学院,南京鼓楼医院耳鼻咽喉头颈外科,江苏省医学重点学科,南京鼓楼医院耳鼻咽喉研究所,南京210008

出　　处：《临床耳鼻咽喉头颈外科杂志》2024年第11期1006-1011,共6页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：江苏省科教能力提升工程“十四五”江苏省医学重点学科(No:ZDXK202243)。

摘　　要：目的:探讨电子喉镜结合窄带成像(narrow band imaging,NBI)内镜及其分型在声带白斑诊断中的临床应用价值。方法:回顾性分析2020年9月至2022年11月在南京鼓楼医院门诊就诊,经过电子喉镜和NBI内镜检查,初步诊断为声带白斑,并且均在门诊进行活检,送病理检查的患者资料115例,研究声带白斑的形态特征和NBI分型与病理结果之间的相关性。结果:115例初诊为声带白斑的患者中,病理结果诊断为良性病变46例(40.00%),低度上皮内瘤变29例(25.22%),高度上皮内瘤变(包括原位癌)22例(19.13%),浸润癌(包括可疑浸润癌)18例(15.65%)。声带白斑的单双侧与病理结果的分布差异无统计学意义(P>0.05),声带白斑的大小、厚薄、病变是否均匀、边界是否清晰、是否侵犯前联合、是否对称、年龄是否大于55岁、形态分型、NBI分型与病理结果分布均差异有统计学意义(P<0.05)。形态分型(平坦型、隆起型、粗糙型)3组间两两比较,仅平坦型和粗糙型比较P<0.017,其他2组间比较均P>0.017。NBI分型(Ⅲ、Ⅳ、Ⅴ)的3组间两两比较,均差异有统计学意义(P<0.017)。NBI分型与病理诊断有较高的相关性,相关系数为0.705(P<0.05)。NBI内镜的Ⅳ型为高度上皮内瘤变及癌变的风险是Ⅲ型的9.125倍,Ⅴ型为高度上皮内瘤变及癌变的风险是Ⅲ型的271.078倍。形态分型和NBI分型的曲线下面积分别为0.672和0.896。结论:NBI分型与病理诊断之间有较高的匹配度和关联性,电子喉镜结合NBI内镜对声带白斑有较高的诊断价值,对恶性白斑有较强的预判能力。Objective:To investigate the clinical value of electronic laryngoscope combined with narrow band imaging(NBI)endoscope and its classification in the diagnosis of vocal cord leukoplakia.Methods:A retrospective analysis was performed on 115 cases of patients treated in the Department of Otolaryngology,Head and Neck Surgery,Nanjing Drum Tower Hospital from September 2020 to November 2022.All 115 cases were diagnosed with vocal cord leukogramma using the electronic laryngoscopy and narrow band imaging endoscopy,followed by pathological examination in the outpatient tissue biopsy.The morphological characteristics of vocal cord leukoplakia and the correlation between narrow band imaging classification and pathological results were investigated.Results:Among 115 cases of vocal cord leukoplakia,46 cases(40.00%)were diagnosed as benign lesions.Low grade intraepithelial neoplasia occurred in 29 cases(25.22%).High-grade intraepithelial neoplasia(including carcinoma in situ)occurred in 22 cases(19.13%).Invasive carcinoma(including suspected invasive carcinoma)was found in 18 cases(15.65%).There were no statistical differences in the unilateral and bilateral distribution of vocal cord leukoplakia and pathological results(P>0.05),but there were statistical differences in the size,thickness,lesion uniformity,clear boundary,pre-invasion commissure,symmetry,age over 55 years old,morphological classification,NBI classification and pathological results distribution(P<0.05).The two-by-two comparison among the three groups of morphological classification(flat type,raised type,rough type)showed that P<0.017 was only compared between flat type and rough type,and P>0.017 was compared between the other two groups.The pairwise comparison among the three groups of NBI classification(Ⅲ,Ⅳ,Ⅴ)was statistically significant(P<0.017).There was a high correlation between NBI classification and pathological diagnosis,and the correlation coefficient was 0.705(P<0.05).The risk of high intraepithelial neoplasia and cancerization in typeⅣwas 9.

关 键 词：声带白斑 窄带成像 电子喉镜 喉癌前病变 喉癌 

分 类 号：R767.4[医药卫生—耳鼻咽喉科]