CAJ | 학술논문

目的探讨内镜窄带光谱成像技术联合碘染色检查对进展期食管癌的诊断价值.方法回顾性分析2010年11月至2012年5月于北京大学肿瘤医院接受上消化道内镜检查的162例进展期食管癌患者的临床资料,在内镜检查中依次使用白光内镜、窄带光谱成像技术(窄带光谱内镜)和Lugol碘液染色(染色内镜)观察模式进行观察,分别记录病灶长度.将窄带光谱内镜或染色内镜观察模式下的癌旁异常黏膜作为可疑边界取标本进行活组织病理检查,计算与白光内镜观察模式下测量病灶边界的差值.对接受手术治疗的患者记录手术入路和吻合方式,对未选择手术治疗的患者随访其最终的治疗方式.比较内镜检查前后治疗方案的差异.结果 162例患者中,3种观察模式下测量病灶边界一致者121例,不一致者41例.41例患者中测量差值为1 ～3 cm者22例,＞3 cm且≤5 cm者8例,＞5 cm且≤10 cm者7例,＞ 10 cm者4例；测量差值＞5 cm的患者均为多发斑片状不着色.以上4类患者中,分别有1、2、2、4例最终接受了新辅助放化疗,其余32例患者接受手术治疗.41例病灶边界不一致者取可疑的癌旁黏膜进行活组织病理检查,其中鳞状细胞癌31例、原位癌3例、重度不典型增生7例.153例接受手术治疗的患者中,12例修改了手术方案,其中2例由胸内吻合改为颈部吻合,3例由主动脉弓下吻合改为弓上吻合,7例由单纯经腹手术改为经胸腹两切口手术.结论内镜检查中启用窄带光谱内镜或染色内镜观察模式测量进展期食管癌病灶的准确性更高,对于在3种观察模式下测量病灶边界不一致者应取癌旁异常黏膜进行病理检查,有助于制订更合理的治疗方案.
목적 탐토내경착대광보성상기술연합전염색검사대진전기식관암적진단개치.방법 회고성분석2010년11월지2012년5월우북경대학종류의원접수상소화도내경검사적162례진전기식관암환자적림상자료,재내경검사중의차사용백광내경、착대광보성상기술(착대광보내경)화Lugol전액염색(염색내경)관찰모식진행관찰,분별기록병조장도.장착대광보내경혹염색내경관찰모식하적암방이상점막작위가의변계취표본진행활조직병리검사,계산여백광내경관찰모식하측량병조변계적차치.대접수수술치료적환자기록수술입로화문합방식,대미선택수술치료적환자수방기최종적치료방식.비교내경검사전후치료방안적차이.결과 162례환자중,3충관찰모식하측량병조변계일치자121례,불일치자41례.41례환자중측량차치위1 ～3 cm자22례,＞3 cm차≤5 cm자8례,＞5 cm차≤10 cm자7례,＞ 10 cm자4례；측량차치＞5 cm적환자균위다발반편상불착색.이상4류환자중,분별유1、2、2、4례최종접수료신보조방화료,기여32례환자접수수술치료.41례병조변계불일치자취가의적암방점막진행활조직병리검사,기중린상세포암31례、원위암3례、중도불전형증생7례.153례접수수술치료적환자중,12례수개료수술방안,기중2례유흉내문합개위경부문합,3례유주동맥궁하문합개위궁상문합,7례유단순경복수술개위경흉복량절구수술.결론 내경검사중계용착대광보내경혹염색내경관찰모식측량진전기식관암병조적준학성경고,대우재3충관찰모식하측량병조변계불일치자응취암방이상점막진행병리검사,유조우제정경합리적치료방안.
Objective To investigate the value of narrow band imaging (NBI) and lugol chromo-endoscopy (LCE) in the diagnosis of advanced esophageal carcinoma.Methods The clinical data of 162 patients with advanced esophageal carcinoma who received NBI and LCE at the Cancer Hospital of Peking University from November 2010 to May 2012 were retrospectively analyzed.Esophageal mucosa was first examined using white light imaging (WLI),and then followed by NBI and LCE,and the lengths of the lesions were recorded.Biopsy histology was obtained in all abnormal mucosa which were detected by NBI or LCE.Difference in the length of lesions detected by the NBI/LCE and WLI was calculated.Surgical approach and method of anastomosis were recorded for patients who received surgical treatment,and the final treatment method was recorded for patients who did not receive surgical treatment.Difference in the treatment methods was compared before and after endoscopy.Results The length of the lesions detected by the 3 methods was identical in 121 patients,different in 41 patients.The difference ranged between 1 and 3 cm was observed in 22 patients,＞3 cm and ≤5 cm in 8 patients,＞5 cm and ≤10 cm in 7 patients,＞ 10 cm in 4 patients.Of the patients in the above mentioned 4 categories,there were 1,2,2,4 patients in each category received neo-adjuvant therapy,and the rest patients received operation.Superficial cancer contiguous to the primary lesion was found in 41 patients,including squamous cell carcinoma in 31 patients,carcinoma-in-situ in 3 patients and severe dysplasia in 7 patients.Of the 153 patients who received surgery,the surgical plan for 12 patients was modified.Intrathoracic anastomosis was changed to cervical anastomosis in 2 patients,anastomosis under the aortic arch was changed to anastomosis above the aortic arch in 3 patients,trans-abdominal operation was changed to thoraco-abdominal operation in 7 patients.Conclusions The combination of NBI and LCE is more accurate to evaluate the extent of lesions of advanced esophageal carcinoma,and is useful to decide the treatment protocol.Pathological examination of the adjacent abnormal mucosa should be carried out for patients whose lesion length was inconsistent under different observation methods.