[1]魏晓华,郭俊霞.不同内镜技术在食管癌及癌前病变筛查中的应用价值研究*[J].陕西医学杂志,2019,(5):591-594.
　WEI Xiaohua,GUO Junxia..Application value of different endoscopy techniques in the screening of esophageal cancer and precancerous lesions[J].,2019,(5):591-594.
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不同内镜技术在食管癌及癌前病变筛查中的应用价值研究*
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《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
期数:
2019年5期
页码:
591-594
栏目:
临床研究
出版日期:
2019-05-05

文章信息/Info

Title:
Application value of different endoscopy techniques in the screening of esophageal cancer and precancerous lesions
文章编号:
DOI: 10.3969/j.issn.10007377.2019.05.014
作者:
魏晓华; 郭俊霞
陕西省宝鸡市中心医院（宝鸡 721008）
Author(s):
WEI Xiaohua; GUO Junxia.
Department of Gastroenterology,Baoji Central Hospital in Shaanxi Province(Baoji 721008)
关键词:
食管癌; 癌前病变; 诊断; 窄带成像放大内镜; 超声内镜; 对比研究
Keywords:
Key words Esophageal cancer; Precancerous lesions; Diagnosis; Narrowband imaging magnifying endoscopy; Endoscopic ultrasonography; Comparative study
分类号:
R735.1
文献标志码:
A
摘要:
摘 要 目的：研究不同内镜技术在食管癌（EC）及癌前病变筛查中的应用价值。方法：选取行白光内镜检查后疑似食管病变的患者120例，所有患者均进行窄带成像放大内镜（NBIME）和超声内镜（EUS）检查。以病理学诊断结果为金标准，分析NBIME对早期EC及癌前病变（包括LGIN和HGIN）诊断的符合率，并对EUS的诊断符合率和浸润深度做出评价。结果：病理诊断结果显示，120例患者中， LGIN 16例， HGIN 27例，早期EC 77例。术后病理诊断为LGIN的16例患者中，NBIME诊断为Ⅲ型10例，Ⅳ型6例，诊断符合率为62.50%（10/16）。术后病理诊断为HGIN的27例患者中，NBIME诊断为Ⅳ型14例，Ⅴ1 型5例，Ⅴ2型8例，诊断符合率为81.48%（22/27）。术后病理诊断为早期EC的77例患者中，NBIME诊断为Ⅴ1 型15例，Ⅴ2型31例，Ⅴ3型29例，ⅤN型2例，诊断符合率为100%（77/77）。NBIME对癌前病变和早期EC的诊断符合率分别为74.42%（32/43）和100%（77/77），针对不同病变类型（LGIN、HGIN和早期EC），NBIME的诊断符合率差异有统计学意义（P＜0.05）。与术后病理诊断相比，NBIME的总体诊断符合率为90.83%（109/120）。EUS诊断结果中，诊断不足8例（6.67%），诊断过度12例（10.00%），癌前病变及黏膜内癌的诊断符合率为85.71%（60/70），黏膜下癌的诊断符合率为83.33%（40/48），针对癌前病变及黏膜内癌、黏膜下癌的诊断符合率相比，差异无统计学意义（P＞0.05），总体诊断符合率为83.33%（100/120）。结论：NBIME和EUS针对早期EC和癌前病变均有较高的诊断价值，NBIME能够从血管形态上反应病灶的恶性程度，EUS能够根据病灶的浸润程度对疾病进行诊断，两者联合应用可有效提高早期EC及癌前病变的诊断准确性。
Abstract:
Abstract Objective：To study the application value of different endoscopy techniques in the screening of esophageal cancer (EC) and precancerous lesions. Methods: 120 patients with suspected esophageal lesions after white light endoscopy were enrolled.All patients underwent narrowband imaging magnifying endoscopy (NBIME) and endoscopic ultrasonography (EUS). Based on the pathological diagnosis as the gold standard, the coincidence rate of NBIME on the diagnosis of early EC and precancerous lesions (including LGIN and HGIN) was analyzed, and the diagnostic coincidence rate and infiltration depth of EUS were evaluated. Results: Pathological diagnosis showed that among 120 patients, 16 were LGIN, 27 were HGIN, and 77 were early EC. Among the 16 patients with pathological diagnosis of LGIN, NBIME was diagnosed as type III in 10 cases and type IV in 6 cases. The diagnostic coincidence rate was 62.50% (10/16). Among the 27 patients with pathological diagnosis of HGIN, NBIME was diagnosed as type IV in 14 cases, V1 type in 5 cases, and V2 type in 8 cases. The diagnostic coincidence rate was 81.48% (22/27). Among the 77 patients with pathological diagnosis of early EC, NBIME was diagnosed as V1 type in 15 cases, V2 type in 31 cases, V3 type in 29 cases, and VN type in 2 cases. The diagnostic coincidence rate was 100% (77/77). The diagnostic rates of NBIME for precancerous lesions and early EC were 74.42% (32/43) and 100% (77/77), respectively, for the diagnosis of NBIME for different lesion types (LGIN, HGIN, and early〖LM〗 EC), the coincidence rate was significantly different (P＜0.05). Compared with postoperative pathological diagnosis, the overall diagnostic coincidence rate of NBIME was 90.83% (109/120). In the EUS diagnosis, 8 cases (6.67%) were not fully diagnosed, and 12 cases (10.00%) were overdiagnosed, the prevalence of precancerous lesions and intramucosal cancer was 85.71% (60/70), and the diagnostic coincidence rate of submucosal cancer was 83.33% (40/48), there was no significant difference in the diagnostic coincidence rate between precancerous lesions and intramucosal cancer and submucosal cancer (P＞0.05). The overall diagnostic coincidence rate was 83.33% (100/120). Conclusion: NBIME and EUS have high diagnostic value for early EC and precancerous lesions. NBIME can reflect the malignant degree of lesions from vascular morphology, and EUS can diagnose the disease according to the degree of infiltration of the lesion. Combined application of the two can effectively improve the diagnostic accuracy of early EC and precancerous lesions.

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备注/Memo

备注/Memo:
*陕西省自然科学基金资助项目（2017JM8084）
更新日期/Last Update: 2019-05-07