本文選題：窄帶成像技術 + 上皮乳頭內毛細血管袢�。� 參考：《山西醫(yī)科大學》2015年碩士論文

【摘要】：目的:探討窄帶成像技術結合放大內鏡對早期食管癌及癌前病變的診斷價值。方法:分別運用普通白光內鏡、NBI、染色內鏡對發(fā)現(xiàn)食管黏膜異常者進行觀察,評價三種方法對早期食管癌及癌前病變的檢出率;對三種方法清晰度進行分析;在NBI下聯(lián)合放大內鏡觀察鱗狀上皮乳頭內毛細血管袢(IPCL)的改變并進行分級,于疑似病變最明顯處行活檢并對其進行病理組織學檢查;確診為早期食管癌及癌前病變的患者,行內鏡黏膜切除術/內鏡黏膜下切除術,進行術前術后病理組織學檢查結果進行對比;比較NBI分級、碘染色分級與病理的關系。結果:(1)普通白光內鏡、NBI與染色內鏡的符合率分別為53.44%、83.21%、87.02%。數(shù)據(jù)顯示:NBI及碘染色與病理的符合率明顯高于普通白光內鏡。(2)NBI診斷食管上段早癌及癌前疾病具有顯著的優(yōu)勢。(3)NBI與染色內鏡觀察病變邊界清晰度比較無差異(P=0.465)。NBI下A8模式以黏膜腺管開口為觀察對象,B8模式以微細血管為觀察對象,均優(yōu)于染色內鏡。(4)高級別上皮內瘤變和早期癌主要表現(xiàn)為NBI I級有56處、NBI II、III級有11處,陰性有30處。低級別上皮內瘤變主要表現(xiàn)為NBI I級有8處、NBI II、III級有31處,陰性有8處。統(tǒng)計結果相關分析Spearman=0.656,P=0.000。一致性Kappa=0.535,P=0.000。HGIN和早期癌主要表現(xiàn)為NBI碘染色I級有60處、NBI II、III級有7處,陰性有4處。LGIN主要表現(xiàn)為NBI I級有7處、NBI II、III級有35處,陰性有5處。統(tǒng)計結果相關分析Spearman=0.733,P=0.000。一致性Kappa=0.689,P=0.000。數(shù)據(jù)表明:NBI分級、碘染色分級在全程食管下與病理具有相關性。(5)食管炎患者IPCL分型以I、II型為主,I-II型占84.62%;LGIN患者IPCL以II、III型為主,II、III型占63.83%;HGIN患者IPCL分型以IV型為主,IV型占71.19%;早期食管癌患者以V1、V2、V3為主,V1、V2、V3占100%。數(shù)據(jù)表明:IPCL形態(tài)分型與病理一致。結論:窄帶成像技術(NBI)是一種通過特殊的光譜變化能夠使黏膜表面的微血管及黏膜表面形態(tài)得到強化的光學圖像增強技術。通過放大內鏡可以觀察IPCL形態(tài),反映組織不典型增生及小病灶的組織學特點并可指導內鏡下對病變的靶向活檢。故NBI聯(lián)合放大內鏡對早癌及癌前病變診斷有臨床應用價值,值得進一步推廣研究。
[Abstract]:Objective: to evaluate the diagnostic value of narrowband imaging combined with magnifying endoscopy for early esophageal carcinoma and precancerous lesions. Methods: normal white light endoscopy and staining endoscopy were used to observe the abnormal esophageal mucosa, to evaluate the detectable rate of early esophageal carcinoma and precancerous lesions, to analyze the definition of the three methods. The changes of IPCLs in squamous epithelial papilla were observed under NBI combined with magnifying endoscopy, and the most obvious lesions were examined by biopsy and histopathology, and the patients with early esophageal cancer and precancerous lesions were diagnosed as early esophageal cancer and precancerous lesions. Endoscopic mucosal resection / endoscopic submucosal resection were performed to compare the results of preoperative and postoperative histopathology, and to compare the relationship between NBI grade, iodine staining grade and pathology. Results the coincidence rates of NBI and staining endoscopy were 53.44 and 83.21, respectively. The data showed that the coincidence rate between the pathological changes and the proportion of 1% NBI and iodine staining was significantly higher than that of the normal white light endoscopy in the diagnosis of upper esophageal early carcinoma and precancerous diseases. There was no significant difference in the definition of the lesion boundary between the upper esophageal carcinoma and the staining endoscopy. The model was based on the opening of mucosal ducts, and the B8 model was used to observe the fine blood vessels. The main manifestations of high grade intraepithelial neoplasia and early carcinoma were 56 cases of NBI grade I, 11 cases of grade III of NBI II and 30 cases of negative. In the low grade intraepithelial neoplasia, there were 8 cases of NBI I grade and 31 cases of NBI II III grade, and 8 cases were negative. The correlation analysis of the statistical results showed that Spearmania was 0.656Pu 0.000. The results showed that there were 60 NBI iodine staining grade I and 7 NBI-III grade, 4 negative. LGIN mainly showed NBI I grade 7, NBI-III grade 35 and negative grade 5. The results were as follows: Kappa: 0.535A: P0. 000.HGIN and early carcinomas showed that there were 60 cases of NBI iodine staining grade I and 7 cases of NBIIII grade III, and 7 cases of negative staining, and 7 cases of NBI grade I and 35 cases of NBI-III grade negative. The correlation analysis of the statistical results showed that Spearmania was 0.733Pu 0.000. The consistency of Kappaa is 0.689 and 0.000. The data show that the: NBI rating, The IPCL classification of patients with esophagitis was mainly I-II and 84.62LGIN. The main type of IPCL in patients with esophagitis was type IV (63.833.83%) and the group of patients with early esophageal carcinoma was V1V2V3 (V1V2V3) and V1V2V3 (100%). The data showed that the morphologic classification of WIPCL was consistent with pathology. Conclusion: narrow band imaging (NBI) is an optical image enhancement technique which can enhance the microvessel and morphology of mucosal surface through special spectral changes. The morphology of IPCL can be observed by magnifying endoscopy, which can reflect the histological characteristics of atypical hyperplasia and small lesions, and can guide the target biopsy of lesions under endoscope. Therefore, NBI combined with magnifying endoscopy has clinical value in the diagnosis of early cancer and precancerous lesions.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R735.1

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相關期刊論文 前1條

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本文編號：1815952