CAJ | 학술논문

目的探讨窄带光谱成像技术(NBI)对大肠增生性病变的诊断价值.方法在白光及NBI模式下分别对大肠可疑病灶进行观察、诊断,以活检病理学检查结果作为金标准,对比NBI与传统肠镜诊断大肠炎性增生、腺痛、早癌及进展期肿瘤的敏感性及特异性.采用NBI模式结合放大内镜观察各种大肠增生性病灶的腺管开口分型及病灶表面微血管形态并进行评分,总结NBI下大肠各种增生性病灶的内镜下特点.结果 (1)传统肠镜及NBI技术检查280例患者共发现368处病灶,NBI诊断大肠炎性增生、腺瘤及早癌的敏感性及特异性明显高于传统肠镜.(2)NBI下大肠炎性增生的腺管开口多为Ⅰ、Ⅱ型,腺瘤多为Ⅱ、Ⅲ型(共占94.2%),早癌的腺管开口可为Ⅲ(18.8%)、Ⅳ(56.3%)和Ⅴ型(25.0%),进展期肿瘤多为Ⅴ型开口(94.0%).(3)NBI下大肠炎性增生、腺瘤、早癌及进展期恶性肿瘤的微血管形态学平均评分分别为1.35±0.72、3.86±1.07、6.52±2.59和11.42±3.59,评分在6.5分以上病灶高度提示为恶性病灶.结论 NBI在鉴别诊断大肠增生性病灶的敏感性及特异性明显高于传统肠镜,NBI结合放大内镜对病灶腺管开口分型及微血管形态的观察能帮助预测病灶的病理性质.
목적 탐토착대광보성상기술(NBI)대대장증생성병변적진단개치.방법 재백광급NBI모식하분별대대장가의병조진행관찰、진단,이활검병이학검사결과작위금표준,대비NBI여전통장경진단대장염성증생、선통、조암급진전기종류적민감성급특이성.채용NBI모식결합방대내경관찰각충대장증생성병조적선관개구분형급병조표면미혈관형태병진행평분,총결NBI하대장각충증생성병조적내경하특점.결과 (1)전통장경급NBI기술검사280례환자공발현368처병조,NBI진단대장염성증생、선류급조암적민감성급특이성명현고우전통장경.(2)NBI하대장염성증생적선관개구다위Ⅰ、Ⅱ형,선류다위Ⅱ、Ⅲ형(공점94.2%),조암적선관개구가위Ⅲ(18.8%)、Ⅳ(56.3%)화Ⅴ형(25.0%),진전기종류다위Ⅴ형개구(94.0%).(3)NBI하대장염성증생、선류、조암급진전기악성종류적미혈관형태학평균평분분별위1.35±0.72、3.86±1.07、6.52±2.59화11.42±3.59,평분재6.5분이상병조고도제시위악성병조.결론 NBI재감별진단대장증생성병조적민감성급특이성명현고우전통장경,NBI결합방대내경대병조선관개구분형급미혈관형태적관찰능방조예측병조적병이성질.
Objective To evaluate the narrow-band imaging (NBI) in differential diagnosis of colo-rectal proliferative lesions. Methods Suspected lesions in colon were examined with white light and NBI colonoscopy, respectively. The ensitivity and specificity in diagnosing colorectal inflammatory hyperplasia, adenoma, early cancer and advanced cancer were compared between NBI and conventional colonoscopy with reference to pathology as gold standard. The pit patterns and the surface microvessels of the lesions were also determined and scored with NBI combined with magnifying endoscopy, and were compared with pathological diagnosis. Results (1) A total of 368 lesions were detected in 280 patients with conventional colonoscopy and NBI. The sensitivity and specificity of NBI in differential diagnosis of colorectal lesions were superior to those of conventional colonoscopy. (2) The pit patterns of colorectal inflammatory hyperplasia were mainly type Ⅰ and Ⅱ , while in adenomas were mainly type Ⅱ and Ⅲ (94. 2%). The pit patterns of early cancer were type Ⅲ (18. 8%), Ⅳ (56. 3%) and Ⅴ (25.0%), and those of advanced cancer were mainly type Ⅴ (94. 0%). (3) The average scores of surface microvesseis of colorectal inflammatory hyperplasia, ade-noma, early cancer and advanced cancer were 1.35 ± 0. 72, 3. 86 ±1.07, 6. 52±2. 59 and 11.42 ± 3.59, respectively. Scores over 6. 5 was a strong indicator of malignant lesions. Conclusion NBI is superior to conventional eolonoscopy in differential diagnosis of colorectal lesions. Observing pit patterns and microves-sels of the lesion with combination of NBI and magnifying endoscopy is helpful in diagnosis.