CAJ | 학술논문

目的探讨内镜窄带成像技术(NBI)对早期胃癌及异型增生的诊断价值.方法 217例普通胃镜和(或)NBI下表现异常者,依次采用普通放大、NBI结合放大、靛胭脂染色并放大观察,评价各检查方法图像的清晰度,并在NBI模式下于改变最显著部位活检行病理学检查.胃癌和重度异型增生者行内镜超声检查(EUS),早期胃癌和重度异型增生者行内镜下治疗或手术治疗.结果在观察病变轮廓方面,NBI与染色内镜或普通内镜之间差异均有统计学意义,NBI最清晰,尤其是对于局灶性浅表性病变的观察;对于胃小凹的形态观察,NBI或染色内镜均优于普通内镜;在对胃黏膜微血管的观察中,NBI具有绝对优势.217例中发现轻度异型增生19例,中度异型增生9例,重度异型增生4例,早期胃癌5例.NBI模式下,胃小凹形态分为6种类型,异型增生主要表现为V1型及Ⅳ型,早期胃癌主要表现为Ⅵ型.NBI放大内镜下3例早期胃癌可见新生或粗大血管,其中2例观察到螺旋形毛细血管.结论 NBI技术操作简便,对胃黏膜病变轮廓显示清晰,放大后更可清晰观察到胃小凹及微血管形态,有助于提高早期胃癌及异型增生的靶向活检准确率.
목적 탐토내경착대성상기술(NBI)대조기위암급이형증생적진단개치.방법 217례보통위경화(혹)NBI하표현이상자,의차채용보통방대、NBI결합방대、전연지염색병방대관찰,평개각검사방법도상적청석도,병재NBI모식하우개변최현저부위활검행병이학검사.위암화중도이형증생자행내경초성검사(EUS),조기위암화중도이형증생자행내경하치료혹수술치료.결과 재관찰병변륜곽방면,NBI여염색내경혹보통내경지간차이균유통계학의의,NBI최청석,우기시대우국조성천표성병변적관찰;대우위소요적형태관찰,NBI혹염색내경균우우보통내경;재대위점막미혈관적관찰중,NBI구유절대우세.217례중발현경도이형증생19례,중도이형증생9례,중도이형증생4례,조기위암5례.NBI모식하,위소요형태분위6충류형,이형증생주요표현위V1형급Ⅳ형,조기위암주요표현위Ⅵ형.NBI방대내경하3례조기위암가견신생혹조대혈관,기중2례관찰도라선형모세혈관.결론 NBI기술조작간편,대위점막병변륜곽현시청석,방대후경가청석관찰도위소요급미혈관형태,유조우제고조기위암급이형증생적파향활검준학솔.
Objective To investigate the value of narrow band imaging(NBI) in diagnosis of early gastric cancer(EGC) and dysplasia. Methods 217 patients were enrolled. Routine endoscopy followed by narrow band imaging (NBI), then chromoendoscopy (indigo carmine) combined magnifying endoscopy was sequentially used. The gastric pits and microvasculuture were carefully observed. According to the NBI ima-ges, the biopsy samples were taken in suspicious area to identify malignant and premalignant gastric lesions. The patients with gastric cancer or severe dysplasia required endoscopic uhrasonography(EUS), then EGC or severe dysplasia ones needed endoscopic therapy or surgery. Results In silhouette of gastric lesion, NBI is the clearest in the above three endoscopic methods. Both mucosal pit and epithelium capiUary were shown much clearer by NBI than by routine endoscopy. Of 217 patients, 19 cases of mild dysplasia, 9 cases of moderate dysplasia, 4 cases of severe dysplasia and 5 cases of EGC were finded according to histopathological diagnosis. Six patterns of gastric pits were summarized by NBI. Dysplasia usually behaviored as V1 or Ⅳ gastric pits,and Ⅵ mucosal pit were suspected malignant lesion. Tumorous vessels can be seen in 3 cases of EGC. Conclusion By narrow band imaging system with magnifying endoscopy, the micro gastric mucosal structure can be shown much clear. That is helpful for improving the accuracy of malignant lesion on endo-scopic target biopsies and finding early gastric cancer.