内镜窄带成像术在胃早期癌性病变诊断和治疗中的价值
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摘要
为探讨胃早期癌性病变应用消化内镜诊疗的价值,本研究选取疑似胃早期癌性病变患者110例,根据患者选取的治疗方案,分为观察组(n=58)和对照组(n=52),对照组采用常规内窥镜检查,行外科剖腹手术治疗,观察组采用内镜窄带成像术(NBI)检查,行内镜下黏膜切除术治疗。观察两组诊断价值、手术时间、术中出血量等。观察组和对照组病理结果诊断胃早期癌性病变分别33例和29例,两组病理结果比较差异无统计学意义(p>0.05);观察组诊断胃早期癌性病变的灵敏度、特异度和准确度分别为93.94%、92.00%和93.10%,明显高于对照组(p<0.05);观察组胃早期癌性病变手术时间、术中出血量、住院时间和治疗费用分别为(41.02±4.29) min、(55.31±5.22) m L、(5.10±1.20) d和(1.53±0.30)万元,明显少于对照组(p<0.05)。胃早期癌性病变诊断中,NBI有较高的诊断价值,同时内镜下黏膜切除术具有创伤小、安全、有效等优点。
To explore the value of digestive endoscopy in the diagnosis and treatment of early gastric cancerous lesions, 110 cases of suspected early gastric cancerous lesions in our hospital were selected and divided into observation group(n=58) and control group(n=52) according to the treatment plan, the control group was treated by conventional endoscopy and surgical laparotomy, the observation group was treated by endoscopic narrow band imaging(NBI) and endoscopic mucosal resection, the diagnostic value, the time of operation and the amount of bleeding during the operation etc in of the two groups were observed. Results: The pathological results of the observation group and the control group were diagnosed in 33 cases and 29 cases in the early gastric cancerous lesions, and there was no significant difference in the pathological results between the two groups(p>0.05); The sensitivity, specificity and accuracy of the diagnosis of early gastric cancerous lesions in the observation group were 93.94%, 92.00% and 93.10%, which were significantly higher than those in the control group(p<0.05); The operative time, intraoperative blood loss, hospitalization time and treatment cost of early gastric cancerous lesions in the observation group were(41.02 ±4.29) min,(55.31±5.22) m L,(5.10±1.20) d and(1.53 ±0.30) ten thousand yuan, which was significantly less than that in the control group(p<0.05). In the diagnosis of early gastric cancerous lesions, NBI has a high diagnostic value, and endoscopic submucosal resection has the advantages of small trauma,safety and effectiveness etc.
To explore the value of digestive endoscopy in the diagnosis and treatment of early gastric cancerous lesions, 110 cases of suspected early gastric cancerous lesions in our hospital were selected and divided into observation group(n=58) and control group(n=52) according to the treatment plan, the control group was treated by conventional endoscopy and surgical laparotomy, the observation group was treated by endoscopic narrow band imaging(NBI) and endoscopic mucosal resection, the diagnostic value, the time of operation and the amount of bleeding during the operation etc in of the two groups were observed. Results: The pathological results of the observation group and the control group were diagnosed in 33 cases and 29 cases in the early gastric cancerous lesions, and there was no significant difference in the pathological results between the two groups(p>0.05); The sensitivity, specificity and accuracy of the diagnosis of early gastric cancerous lesions in the observation group were 93.94%, 92.00% and 93.10%, which were significantly higher than those in the control group(p<0.05); The operative time, intraoperative blood loss, hospitalization time and treatment cost of early gastric cancerous lesions in the observation group were(41.02 ±4.29) min,(55.31±5.22) m L,(5.10±1.20) d and(1.53 ±0.30) ten thousand yuan, which was significantly less than that in the control group(p<0.05). In the diagnosis of early gastric cancerous lesions, NBI has a high diagnostic value, and endoscopic submucosal resection has the advantages of small trauma,safety and effectiveness etc.
引文
Akagi T.,Mukai T.,Kodama S.,and Morita Y.,2017,POEMSsyndrome in a patient with rheumatoid arthritis,BMJ Case Rep.,2017:bcr-2017-220875
Chen Y.B.,Zhao M.,Yan J.Y.,Lei P.G.,Du Z.S.,and Cui Y.,2015,Value of narrow-band imaging combined with endoscopic utrasonography in diagnosis and treatment of early esophageal cancer and precancerous lesions,Zhongguo Linchuang Yanjiu(Chinese Journal of Clinical Research),28(8):996-999(陈远博,赵妙,晏洁影,雷平光,杜震生,崔毅,2015,窄带成像技术联合超声内镜对早期食管癌及癌前病变的诊治价值,中国临床研究,28(8):996-999)
Jiao Y.,Li Y.,Wu D.,Fang W.G.,and Lu X.H.,2016,Cost-effectiveness analysis of different enhanced magnifying endoscopic technologies for early gastric cancer screening,Zhonghua Xiaohuaneijing Zazhi(Chinese Journal of Diges tive Endoscopy),33(9):613-617(焦洋,李玥,吴东,方卫纲,陆星华,2016,不同内镜技术进行早期胃癌筛查的成本效果分析,中华消化内镜杂志,33(9):613-617)
Jin Y.,Gong L.,Tang X.J.,Wang X.Y.,Peng X.B.,Wu G.J.,Yao L.Q.,and Shi Q.,2016,Clinical value of the narrow-band imaging combined with endoscopic submucosal dissection for gastric high grade intraepithelial neoplasia,Zhonghua Weichang Waike Zazhi(Chinese Journal of Gastrointestinal Surgery),19(5):557-561(金燕,龚镭,唐学军,王小云,彭晓斌,吴高珏,姚礼庆,时强,2016,窄带成像技术联合内镜黏膜下剥离术治疗胃黏膜高级别上皮内瘤变的临床价值,中华胃肠外科杂志,19(5):557-561)
Joseph R.R.,Lacey L.S.,and Andrew M.K.,2017,Anal intraepithelial neoplasia:A review of diagnosis and management,World J.Gastrointest Oncol.,9(2):50-61
Korde N.,Kristinsson S.Y.,and Landgren O.,2011,Monoclonal gammopathy of undetermined significance(MGUS)and smoldering multiple myeloma(SMM):novel biological insights and development of early treatment strategies,Blood,117(21):5573-5581
Lebwohl M.,2003,Actinic keratosis:epidemiology and progression to squamous cell carcinoma,Br.J.Dermatol.,149(Suppl 66):31-33
Liao Y.Y.,Xie R.Y.,and Feng L.L.,2008,Cervical precancerous lesions,cervical cancer screening method and clinical analysis,Modern Hospital,25(1):188-194
Machida H.,Sano Y.,Hamamoto Y.,Muto M.,Kozu T.,Tajiri H.,and Yoshida S.,2004,Narrow-band imaging in the diagnosis of colorectal mucosal lesions:a pilot study,Endoscopy,36(12):1094-1098
Niu H.S.,Chen H.H.,Fu Y.W.,Cui H.,Chen J.,and Yang J.,2015,Value of magnifying endoscopy with narrow band imaging to observe microvascular architecture for diagnosis of early gastric cancer,Weichangbingxue He Ganbingxue Zazhi(Chinese Journal of Gastroenterology and Hepatology),24(10):1192-1195(牛昊书,陈海华,伏亦伟,崔宏,陈吉,杨洁,2015,窄带成像结合放大内镜技术观察胃表面微血管在早期胃癌诊断中的价值,胃肠病学和肝病学杂志,24(10):1192-1195)
Sharma P.,Bansal A.,Mathur S.,Wani S.,Cherian R.,McGregor D.,Higbee A.,Hall S.,and Weston A.,2006,The utility of a novel narrow band imaging endoscopy system in patients with Barrett's esophagus,Gastrointest Endosc.,64(2):167-175
Tang Y.,Liu P.F.,Wang F.J.,Qiu Q.X.,Xu W.,Hu X.J.,Yao P.,Li K.F.,Liu Y.,and Chen H.,2015,The diagnostic value of NBI combined with magnifying endoscopy using VS classification standard for;early gastric carcinoma lesions,Zhonghua Xiaohuaneijing Zazhi(Chinese Journal of Digestive Endoscopy),32(9):595-599(汤瑜,刘鹏飞,王芳军,邱全兴,徐威,胡学军,姚平,李葵芳,刘烨,陈洪,2015,内镜窄带成像结合放大技术应用VS分类标准对胃早期癌性病变的诊断价值研究,中华消化内镜杂志,32(9):595-599)
Teng C.Y.,Sun Y.H.,Chen F.,Wang Y.,and Zhu H.H.,2015,E-valuation of magnification chromoendoscopy combined with narrow-band imaging for diagnosis of neoplasia lesions of early gastric cancer,Zhonghua Xiaohuaneijing Zazhi(Chinese Journal of Digestive Endoscopy),32(8):553-557(滕春雨,孙咏红,陈浮,王宇,朱海杭,2015,放大色素内镜结合窄带成像技术对早期胃癌诊断的临床价值研究,中华消化内镜杂志,32(8):553-557)
Wang F.J.,Zhao K.,Wang J.,Liu B.T.,Wang W.P.,Gao Y.,Liu H.M.,and Liu P.F.,2016,Value of magnifying endoscopy with narrow-band imaging in diagnosis of 124 early gastric neoplastic lesions,Zhonghua Xiaohua Zazhi(Chinese Journal of Digestion),36(6):391-396(王芳军,赵可,汪娟,刘兵团,王文平,高昳,刘华敏,刘鹏飞,2016,放大内镜结合窄带成像下微腺管密度对124例胃早期肿瘤性病变的诊断价值,中华消化杂志,36(6):391-396)
Wang L.,Zhan Q.,and Wang H.,2015,Application value of narrow band imaging in the diagnosis of early gastric cancer and precancerous lesions,Shiyong Aizheng Zazhi(The Practical Journal of Cancer),30(11):1663-1665(王磊,占强,王辉,2015,早期胃癌及癌前病变诊断中内镜窄带成像技术的应用价值分析,实用癌症杂志,30(11):1663-1665)
Wang W.,Hao L.,Shi X.G.,Jin Z.D.,and Li Z.S.,2017,Clinical value of endoscopic submucosal dissection in early gastric cancer and precancerous lesion,Dier Junyi Daxue Xuebao(Academic Journal of Second Military Medical University),38(7):923-927(王伟,郝璐,施新岗,金震东,李兆申,2017,内镜黏膜下剥离术在早期胃癌及癌前病变治疗中的价值,第二军医大学学报,38(7):923-927)
Yardimci G.,Kutlubay Z.,Engin B.,and Tuzun Y.,2014,Precancerous lesions of oral mucosa,World Journal of Clinical Cases,2(12):866
Yoshida T.,Inoue H.,Usui S.,Satodate H.,Fukami N.,and Kudo S.E.,2004,Narrow-band imaging system with magnifying endoscopy for superficial esophageal lesions,Gastrointest Endosc.,59(2):288-295
Zeng H.L.,and Zhang Z.K.,2016,Value of magnifying endoscopy-narrow band imaging technology for the diagnosis of early cancer and precancerous lesions in upper digestive tract,Zhongguo Linchuang Yanjiu(Chinese Journal of Clinical Research),29(4):452-455(曾海龙,张正坤,2016,放大内镜结合窄带成像技术对上消化道早期癌及癌前病变的诊断价值,中国临床研究,29(4):452-455)
Zhong B.,Cui H.Y.,Hou F.J.,and Huang S.Q.,2016,Endoscopic narrowband imaging in the diagnosis of early gastric cancer and precancerous lesions,Shiyong Aizheng Zazhi(The Practical Journal of Cancer),31(6):997-999(钟斌,崔红义,候凤杰,黄盛秋,2016,内镜窄带成像技术对早期胃癌及癌前病变的诊断价值,实用癌症杂志,31(6):997-999)
Chen Y.B.,Zhao M.,Yan J.Y.,Lei P.G.,Du Z.S.,and Cui Y.,2015,Value of narrow-band imaging combined with endoscopic utrasonography in diagnosis and treatment of early esophageal cancer and precancerous lesions,Zhongguo Linchuang Yanjiu(Chinese Journal of Clinical Research),28(8):996-999(陈远博,赵妙,晏洁影,雷平光,杜震生,崔毅,2015,窄带成像技术联合超声内镜对早期食管癌及癌前病变的诊治价值,中国临床研究,28(8):996-999)
Jiao Y.,Li Y.,Wu D.,Fang W.G.,and Lu X.H.,2016,Cost-effectiveness analysis of different enhanced magnifying endoscopic technologies for early gastric cancer screening,Zhonghua Xiaohuaneijing Zazhi(Chinese Journal of Diges tive Endoscopy),33(9):613-617(焦洋,李玥,吴东,方卫纲,陆星华,2016,不同内镜技术进行早期胃癌筛查的成本效果分析,中华消化内镜杂志,33(9):613-617)
Jin Y.,Gong L.,Tang X.J.,Wang X.Y.,Peng X.B.,Wu G.J.,Yao L.Q.,and Shi Q.,2016,Clinical value of the narrow-band imaging combined with endoscopic submucosal dissection for gastric high grade intraepithelial neoplasia,Zhonghua Weichang Waike Zazhi(Chinese Journal of Gastrointestinal Surgery),19(5):557-561(金燕,龚镭,唐学军,王小云,彭晓斌,吴高珏,姚礼庆,时强,2016,窄带成像技术联合内镜黏膜下剥离术治疗胃黏膜高级别上皮内瘤变的临床价值,中华胃肠外科杂志,19(5):557-561)
Joseph R.R.,Lacey L.S.,and Andrew M.K.,2017,Anal intraepithelial neoplasia:A review of diagnosis and management,World J.Gastrointest Oncol.,9(2):50-61
Korde N.,Kristinsson S.Y.,and Landgren O.,2011,Monoclonal gammopathy of undetermined significance(MGUS)and smoldering multiple myeloma(SMM):novel biological insights and development of early treatment strategies,Blood,117(21):5573-5581
Lebwohl M.,2003,Actinic keratosis:epidemiology and progression to squamous cell carcinoma,Br.J.Dermatol.,149(Suppl 66):31-33
Liao Y.Y.,Xie R.Y.,and Feng L.L.,2008,Cervical precancerous lesions,cervical cancer screening method and clinical analysis,Modern Hospital,25(1):188-194
Machida H.,Sano Y.,Hamamoto Y.,Muto M.,Kozu T.,Tajiri H.,and Yoshida S.,2004,Narrow-band imaging in the diagnosis of colorectal mucosal lesions:a pilot study,Endoscopy,36(12):1094-1098
Niu H.S.,Chen H.H.,Fu Y.W.,Cui H.,Chen J.,and Yang J.,2015,Value of magnifying endoscopy with narrow band imaging to observe microvascular architecture for diagnosis of early gastric cancer,Weichangbingxue He Ganbingxue Zazhi(Chinese Journal of Gastroenterology and Hepatology),24(10):1192-1195(牛昊书,陈海华,伏亦伟,崔宏,陈吉,杨洁,2015,窄带成像结合放大内镜技术观察胃表面微血管在早期胃癌诊断中的价值,胃肠病学和肝病学杂志,24(10):1192-1195)
Sharma P.,Bansal A.,Mathur S.,Wani S.,Cherian R.,McGregor D.,Higbee A.,Hall S.,and Weston A.,2006,The utility of a novel narrow band imaging endoscopy system in patients with Barrett's esophagus,Gastrointest Endosc.,64(2):167-175
Tang Y.,Liu P.F.,Wang F.J.,Qiu Q.X.,Xu W.,Hu X.J.,Yao P.,Li K.F.,Liu Y.,and Chen H.,2015,The diagnostic value of NBI combined with magnifying endoscopy using VS classification standard for;early gastric carcinoma lesions,Zhonghua Xiaohuaneijing Zazhi(Chinese Journal of Digestive Endoscopy),32(9):595-599(汤瑜,刘鹏飞,王芳军,邱全兴,徐威,胡学军,姚平,李葵芳,刘烨,陈洪,2015,内镜窄带成像结合放大技术应用VS分类标准对胃早期癌性病变的诊断价值研究,中华消化内镜杂志,32(9):595-599)
Teng C.Y.,Sun Y.H.,Chen F.,Wang Y.,and Zhu H.H.,2015,E-valuation of magnification chromoendoscopy combined with narrow-band imaging for diagnosis of neoplasia lesions of early gastric cancer,Zhonghua Xiaohuaneijing Zazhi(Chinese Journal of Digestive Endoscopy),32(8):553-557(滕春雨,孙咏红,陈浮,王宇,朱海杭,2015,放大色素内镜结合窄带成像技术对早期胃癌诊断的临床价值研究,中华消化内镜杂志,32(8):553-557)
Wang F.J.,Zhao K.,Wang J.,Liu B.T.,Wang W.P.,Gao Y.,Liu H.M.,and Liu P.F.,2016,Value of magnifying endoscopy with narrow-band imaging in diagnosis of 124 early gastric neoplastic lesions,Zhonghua Xiaohua Zazhi(Chinese Journal of Digestion),36(6):391-396(王芳军,赵可,汪娟,刘兵团,王文平,高昳,刘华敏,刘鹏飞,2016,放大内镜结合窄带成像下微腺管密度对124例胃早期肿瘤性病变的诊断价值,中华消化杂志,36(6):391-396)
Wang L.,Zhan Q.,and Wang H.,2015,Application value of narrow band imaging in the diagnosis of early gastric cancer and precancerous lesions,Shiyong Aizheng Zazhi(The Practical Journal of Cancer),30(11):1663-1665(王磊,占强,王辉,2015,早期胃癌及癌前病变诊断中内镜窄带成像技术的应用价值分析,实用癌症杂志,30(11):1663-1665)
Wang W.,Hao L.,Shi X.G.,Jin Z.D.,and Li Z.S.,2017,Clinical value of endoscopic submucosal dissection in early gastric cancer and precancerous lesion,Dier Junyi Daxue Xuebao(Academic Journal of Second Military Medical University),38(7):923-927(王伟,郝璐,施新岗,金震东,李兆申,2017,内镜黏膜下剥离术在早期胃癌及癌前病变治疗中的价值,第二军医大学学报,38(7):923-927)
Yardimci G.,Kutlubay Z.,Engin B.,and Tuzun Y.,2014,Precancerous lesions of oral mucosa,World Journal of Clinical Cases,2(12):866
Yoshida T.,Inoue H.,Usui S.,Satodate H.,Fukami N.,and Kudo S.E.,2004,Narrow-band imaging system with magnifying endoscopy for superficial esophageal lesions,Gastrointest Endosc.,59(2):288-295
Zeng H.L.,and Zhang Z.K.,2016,Value of magnifying endoscopy-narrow band imaging technology for the diagnosis of early cancer and precancerous lesions in upper digestive tract,Zhongguo Linchuang Yanjiu(Chinese Journal of Clinical Research),29(4):452-455(曾海龙,张正坤,2016,放大内镜结合窄带成像技术对上消化道早期癌及癌前病变的诊断价值,中国临床研究,29(4):452-455)
Zhong B.,Cui H.Y.,Hou F.J.,and Huang S.Q.,2016,Endoscopic narrowband imaging in the diagnosis of early gastric cancer and precancerous lesions,Shiyong Aizheng Zazhi(The Practical Journal of Cancer),31(6):997-999(钟斌,崔红义,候凤杰,黄盛秋,2016,内镜窄带成像技术对早期胃癌及癌前病变的诊断价值,实用癌症杂志,31(6):997-999)