【摘要】：目的：探討窄帶成像（narrow band imaging，NBI）內(nèi)鏡在診斷喉癌中的應(yīng)用價值。 方法：研究中病例選取2013年6月至2014年3月因主觀癥狀在我科接受電子喉鏡檢查的患者，患者主訴為咽喉部異物感或不適感，痰中帶血，伴或不伴有聲嘶，病史包括長期吸煙史。對104例懷疑有喉癌或癌前病變的患者分別選用具有普通白光和NBI兩種觀察模式的電子內(nèi)鏡進行咽喉各個部位的檢查。在發(fā)現(xiàn)可疑病灶后先后使用白光和NBI模式觀察并進行分類，操作醫(yī)師對NBI下觀察到的上皮內(nèi)乳頭樣毛細血管袢（intraepithelial papillarycapillary loop，IPCL）進行分型，對病灶性質(zhì)做初步的判斷，以病理診斷作為金標準，比較IPCL形態(tài)特點及其與組織學(xué)分型的對應(yīng)關(guān)系，并比較兩種檢查方法的靈敏度、特異性、陽性預(yù)測值及陰性預(yù)測值。 結(jié)果：（1）NBI模式下觀察，可以清晰的顯示黏膜表層的微血管形態(tài)。當(dāng)黏膜表層發(fā)生病變時，尤其是新生物形成時，IPCL形態(tài)就會發(fā)生改變。惡性病變的NBI內(nèi)鏡特點是病灶區(qū)出現(xiàn)列排不規(guī)則的緊密的棕色斑點，并且病變的邊界能夠較白光顯示的更加清晰。斑點越大越清晰，分布排列越不規(guī)則，惡性的可能性越大。隨著病變的進展，病灶區(qū)毛細血管可呈現(xiàn)為扭曲的條索樣，如蝌蚪形、蚯蚓形、蛇形。重度不典型增生的表現(xiàn)和原位癌表現(xiàn)相似，以較大的棕色斑點為主要特點，而輕度和中度不典型增生的黏膜病灶區(qū)雖可見斑點，但相對明顯縮小，排列較為稀疏、尚規(guī)則。單純性增生因病灶表面多為角化的上皮或增生的鱗狀上皮覆蓋，表現(xiàn)為白色偽膜覆蓋，很難看到斑點。炎性反則表現(xiàn)為黏膜表層的毛細血管擴張。息肉的黏膜表層的血管表現(xiàn)與正常黏膜的相似。 （2）104例懷疑喉癌或癌前病變的患者發(fā)現(xiàn)病灶117個，其中單純性增生16個，輕度不典型增生15個，中度不典型增生7個，息肉12個，，炎性反應(yīng)3個，重度不典型增生6，原位癌9個，浸潤癌49個。 （3）NBI內(nèi)鏡對喉癌診斷的靈敏度為91.4%，而普通白光內(nèi)鏡的靈敏度為74.1%。二者之間的差異有統(tǒng)計學(xué)意義（χ2=6.04, p0.05）。NBI內(nèi)鏡對喉癌診斷的陰性預(yù)測值為91.9%，普通白光內(nèi)鏡的78.6%，兩者間差異有統(tǒng)計學(xué)意義（χ2=4.53, p0.05）。 結(jié)論：窄帶成像技術(shù)（NBI）作為一種新興的內(nèi)鏡下成像診斷技術(shù)，其操作簡單，能清晰地顯現(xiàn)病變的輪廓及黏膜表層及黏膜下層微血管的各種形態(tài)變化，并對初步判斷病理類型有一定的價值。NBI內(nèi)鏡對喉癌診斷的靈敏度及陰性預(yù)測值高于普通白光內(nèi)鏡檢查方法，使之可以成為提高腫瘤檢出率及鑒別腫瘤病變性質(zhì)的有效手段。
[Abstract]:Objective: to evaluate the value of narrow band imaging (narrow band imaging,NBI) endoscopy in the diagnosis of laryngeal carcinoma. Methods: from June 2013 to March 2014, patients who underwent electronic laryngoscope examination in our department due to subjective symptoms were selected. The patients complained of foreign body feeling or discomfort in pharynx and larynx, blood in sputum, with or without hoarseness. Medical history includes a history of long-term smoking. Electronic endoscopy with common white light and NBI was used to examine all parts of pharynx and larynx in 104 patients with suspected laryngeal carcinoma or precancerous lesions. After discovery of suspicious lesions, white light and NBI patterns were used to observe and classify the lesions, and doctors were used to classify the (intraepithelial papillarycapillary loop,IPCL observed in the intraepithelial papilla-like capillary loop under NBI, and to make a preliminary judgement on the nature of the lesions. Using pathological diagnosis as gold standard, the morphological characteristics of IPCL and its corresponding relationship with histologic types were compared, and the sensitivity, specificity, positive predictive value and negative predictive value of the two methods were compared. Results: (1) the morphology of microvessels on the surface of mucous membrane could be clearly displayed by NBI mode. When lesions occur on the surface of the mucous membrane, especially when new organisms are formed, the morphology of IPCL changes. NBI endoscopy of malignant lesions is characterized by irregular and dense brown spots in the lesion area, and the boundary of the lesion can be more clearly displayed than that of white light. The larger the spots, the clearer the distribution and arrangement, and the greater the possibility of malignancy. With the development of the lesion, the capillaries in the lesion area can appear as twisted strips, such as tadpole, earthworm and serpentine. The manifestations of severe atypical hyperplasia were similar to those of carcinoma in situ, characterized by large brown spots, while those in mild and moderate atypical hyperplasia were relatively small, sparsely arranged and regular. Simple hyperplasia is covered with white pseudomembrane because the surface of the lesion is mostly covered by keratinized epithelial or hyperplastic scaly epithelial, so it is difficult to see spots. The inflammatory reaction showed telangiectasia on the surface of the mucous membrane. The vascular appearance on the surface of polyp is similar to that of normal mucosa. (2) 117 lesions were found in 104 patients with suspected laryngeal or precancerous lesions, including 16 simple hyperplasia, 15 mild atypical hyperplasia, 7 moderate atypical hyperplasia, 12 polyps, 3 inflammatory reactions and 6 severe atypical hyperplasia. There were 9 carcinoma in situ and 49 invasive carcinoma. (3) the sensitivity of NBI endoscopy in the diagnosis of laryngeal carcinoma was 91.4%, while that of conventional white light endoscopy was 74.1%. The negative predictive value of NBI endoscopy in the diagnosis of laryngeal carcinoma was 91.9%, and that of ordinary white light endoscopy was 78.6%. There was significant difference between the two groups (蠂 2, 4.53, p 0.05). The negative predictive value of NBI endoscopy in laryngeal carcinoma was 91.9% and 78.6% of that in common white light endoscopy (蠂 2, P 0.05). Conclusion: narrow band imaging (NBI) is a new technique for endoscopic imaging diagnosis. It is easy to operate and can clearly show the contour of the lesion and various morphological changes of the superficial and submucosal microvessels. The sensitivity and negative predictive value of NBI endoscopy in the diagnosis of laryngeal carcinoma are higher than that of ordinary white light endoscopy, which makes it an effective method to improve the detection rate of tumor and differentiate the nature of tumor lesions.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R739.65

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