CAJ | 학술논문

目的：探讨窄带成像技术（narrow band imaging，NBI）在内镜诊断早期咽喉恶性肿瘤及癌前病变中的临床应用价值。方法选取2013年6月至2014年3月因主观症状就诊于我院门诊，经电子喉镜检查发现咽喉粘膜异常增生及喉肿物疑似恶性病变的104例患者，分别在白光和 NBI 模式下观察咽喉部黏膜，记录病变的大小、范围，同时进行 NBI 分级，并对病灶性质做出预判，对 NBI 模式下发现的117个病灶均取活检，以病理结果作为诊断金标准，将其他检查结果与之作对照。结果1．窄带成像技术在对病损轮廓、黏膜表面及粘膜下微血管形态显示方面均明显优于普通白光内镜图像，差异有显著性（P ＜0．05）。2．104例怀疑喉癌或癌前病变的患者中共发现117个病灶，其中白光模式下病变检出率为89．7％，应用 NBI 模式检出率为99．1％。NBI 内镜对咽喉恶性肿瘤及癌前病变诊断的灵敏度为91．4％，而普通白光内镜的灵敏度为74．1％，二者之间的差异有统计学意义。3．NBI 分级与病理诊断的关系：声带息肉等良性病变主要表现为 NBI Ⅰ级（10／12），慢性喉炎等炎性病变主要表现为 NBI Ⅱ级（15／19），轻度不典型增生主要表现为 NBI Ⅲ级（10／15），重度不典型增生主要表现为 NBI Ⅳ级（5／7），重度不典型增生及恶性肿瘤主要表现为 NBI Ⅴ级（52／64）。结论与白光模式相比，NBI 模式能清晰地显现病变的轮廓及黏膜表层及黏膜下层微血管的各种形态变化，可增强病变的可识别性。内镜窄带成像技术操作简便、安全，较白光模式更易发现细微变化的病灶，亦可使活检阳性率明显提高，在早期咽喉恶性肿瘤及癌前病变的诊断有一定的临床应用价值。
목적：탐토착대성상기술（narrow band imaging，NBI）재내경진단조기인후악성종류급암전병변중적림상응용개치。방법선취2013년6월지2014년3월인주관증상취진우아원문진，경전자후경검사발현인후점막이상증생급후종물의사악성병변적104례환자，분별재백광화 NBI 모식하관찰인후부점막，기록병변적대소、범위，동시진행 NBI 분급，병대병조성질주출예판，대 NBI 모식하발현적117개병조균취활검，이병리결과작위진단금표준，장기타검사결과여지작대조。결과1．착대성상기술재대병손륜곽、점막표면급점막하미혈관형태현시방면균명현우우보통백광내경도상，차이유현저성（P ＜0．05）。2．104례부의후암혹암전병변적환자중공발현117개병조，기중백광모식하병변검출솔위89．7％，응용 NBI 모식검출솔위99．1％。NBI 내경대인후악성종류급암전병변진단적령민도위91．4％，이보통백광내경적령민도위74．1％，이자지간적차이유통계학의의。3．NBI 분급여병리진단적관계：성대식육등량성병변주요표현위 NBI Ⅰ급（10／12），만성후염등염성병변주요표현위 NBI Ⅱ급（15／19），경도불전형증생주요표현위 NBI Ⅲ급（10／15），중도불전형증생주요표현위 NBI Ⅳ급（5／7），중도불전형증생급악성종류주요표현위 NBI Ⅴ급（52／64）。결론여백광모식상비，NBI 모식능청석지현현병변적륜곽급점막표층급점막하층미혈관적각충형태변화，가증강병변적가식별성。내경착대성상기술조작간편、안전，교백광모식경역발현세미변화적병조，역가사활검양성솔명현제고，재조기인후악성종류급암전병변적진단유일정적림상응용개치。
Objective To assess the value of narrow band imaging (NBI)in the diagnosis of precancerous lesions and laryngeal cancer in earlier stage.Methods We chose 104 qualified patients who had the suspicion of suffering from laryngeal carcinomas by electronic laryngoscope examination in our department from June 2013 to March 2014.Exam-ined the larynx with normal and NBI scope separately in every case,then observed the size and extent of lesions,as well as the intraepithelial papillary capillary loop (IPCL)on the surface in order to get NBI grading and make anticipation of the lesions.117 lesions were found under NBI model and were biopsied.We use pathological results as the golden stand-ard for diagnosis.Results 1 NBI can display the extent and morphology of the IPCL much better than the ordinary white light inspection.2.117 lesions of laryngeal cancer or precancerous lesions were found in 104 cases.The detection rate of lesions was 89.7% with normal fiber laryngoscope,and the detection rate of NBI was 99.1%.The sensitivity of the diagnosis of laryngeal cancer and precancerous lesions using NBI was 91.4%.Benign lesions of vocal cord polyps showed mainly NBI grade I (10 / 12),chronic laryngitis and other inflammatory lesions mainly showed NBI grade II (15 / 19),mild atypical hyperplasia mainly showed grade III (10/ 15),moderate atypical hyperplasia showed grade IV (5 / 7),severe atypical hyperplasia and malignant tumor mainly showed NBI class V (52/64).Conclusion The NBI endoscopy could show the contour of the lesion,and various morphological changes of the micro vessel in the mucous membrane.The NBI technique has a great advantage in increasing the detection rate of precancerous lesions.NBI can al-so increase the accuracy rate of biopsy targeting and predicte the results of histopathology.So NBI endoscopy has cer-tain clinical application value in early diagnosis of laryngeal carcinoma.