發(fā)布時(shí)間：2018-07-14 15:07

【摘要】：目的探討內(nèi)鏡窄帶成像技術(shù)(NBI)在診斷結(jié)直腸病變中的作用。明確NBI在實(shí)際操作中的學(xué)習(xí)曲線,為開(kāi)展該技術(shù)的臨床醫(yī)師提供指導(dǎo)。方法回顧性分析2015年6月-2016年6月該院內(nèi)鏡中心4位醫(yī)師行NBI結(jié)合放大內(nèi)鏡檢查并發(fā)現(xiàn)結(jié)直腸病變的289例患者臨床資料,所有病變經(jīng)活檢、內(nèi)鏡下治療或手術(shù)后行病理組織學(xué)檢查,并與佐野分型對(duì)照。根據(jù)NBI結(jié)合放大內(nèi)鏡分為3組,這3組包括可以通過(guò)內(nèi)鏡治療(目標(biāo)病變)的病變和不能通過(guò)內(nèi)鏡治療(非目標(biāo)病變)的病變。每位醫(yī)師檢查的目標(biāo)或非目標(biāo)病變均達(dá)到15例為1組。通過(guò)評(píng)估4名醫(yī)師對(duì)每組病變的診斷準(zhǔn)確性,繪制NBI結(jié)合放大內(nèi)鏡檢查技術(shù)的相關(guān)學(xué)習(xí)曲線。結(jié)果在289例患者的結(jié)腸鏡檢查中共發(fā)現(xiàn)372處病變,NBI結(jié)合放大內(nèi)鏡使用佐野分型在鑒別腫瘤和非腫瘤性病變的準(zhǔn)確率為95.1%、敏感性為98.0%、特異性為92.0%。對(duì)于目標(biāo)及非目標(biāo)病變的診斷準(zhǔn)確率第2組相比第1組均有明顯提高[分別為81.7%vs 95.1%(P=0.010)和71.7%vs 93.4%(P=0.000)];第2組與第3組病變之間的診斷準(zhǔn)確率的差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.984及P=0.117)。結(jié)論 NBI結(jié)合放大內(nèi)鏡是診斷結(jié)直腸病變的有效工具。對(duì)于無(wú)NBI經(jīng)驗(yàn)的醫(yī)師在完成較短的訓(xùn)練計(jì)劃和一定(對(duì)目標(biāo)及非目標(biāo)病變各15例)的臨床實(shí)踐后基本掌握其診斷方法,并獲得有效、穩(wěn)定的診斷準(zhǔn)確率。
[Abstract]:Objective to investigate the role of endoscopic narrowband imaging (NBI) in the diagnosis of colorectal lesions. Define the learning curve of NBI in practice and provide guidance to clinicians who develop this technique. Methods from June 2015 to June 2016, the clinical data of 289 patients with colorectal lesions, who underwent NBI combined with magnification endoscopy, were analyzed retrospectively. All lesions were biopsied. Histopathological examination was performed after endoscopic treatment or surgery, and compared with Sasano classification. According to NBI combined with magnified endoscopy, three groups were divided into three groups, including those which could be treated by endoscopy (target lesions) and those that could not be treated by endoscopy (non-target lesions). There were 15 cases of target or non-target lesions in group 1. The learning curves of NBI combined with magnifying endoscopy were drawn by evaluating the diagnostic accuracy of 4 physicians for each group of lesions. Results in 289 patients with colonoscopy, 372 lesions were detected by NBI combined with magnifying endoscopy. The accuracy of Sawfield classification in differentiating tumor from non-neoplastic lesions was 95.1, sensitivity 98.0 and specificity 92.00.Results in 289 patients, the accuracy of NBI combined with Endoscopic Endoscopic typing was 95.1, the sensitivity was 98.0 and the specificity was 92.0. The diagnostic accuracy of target and non-target lesions in group 2 was significantly higher than that in group 1 [81.7%vs 95.1% (P0. 010) and 71.7%vs 93. 4% (P0. 000)], but there was no significant difference between group 2 and group 3 (P0. 984 and P0. 117). Conclusion NBI combined with magnifying endoscopy is an effective tool for the diagnosis of colorectal lesions. For the doctors without NBI experience, after completing a short training plan and a certain clinical practice (15 cases of target and 15 cases of non-target lesions), the diagnosis method was basically grasped, and the effective and stable diagnostic accuracy was obtained.
【作者單位】： 浙江省麗水市中心醫(yī)院消化內(nèi)科;
【分類號(hào)】：R574
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本文編號(hào)：2122035