内镜智能分光比色技术诊断结肠肿瘤性病变临床研究.docVIP

内镜智能分光比色技术诊断结肠肿瘤性病变临床研究 　　【摘要】 目的 探讨内镜智能分光比色技术(FICE)在诊断结肠肿瘤性病变的价值。方法 选择2009年1月至2010年2月期间共781例患者进行常规内镜检查,其中发现结肠新生物或息肉样病变者共236例入选。分别采用常规放大技术、FICE放大技术及染色放大技术对病变进行腺管开口分型及微血管形态观察,对病变作出诊断,并与病理组织学诊断相比较。结果 在236例患者中发现新生性病变431个,其中常规放大内镜下发现病变392个(91.0%),FICE放大模式下发现病变FICE放大内镜发现病变421个(97.9%),二者比较差异有统计学意义。FICE放大内镜比染色放大内镜更能清晰显示黏膜微血管结构形态(P 　　【关键词】智能分光比色技术;结肠肿瘤;诊断 　　 　　A study of Fuji Intelligent Chromo Endoscopy in the diagnosis of colonrectal neoplasia 　　 　　XU Ning,LIU Yun-xiang,HUANG Liu-ye,et al. 　　Digestive systern department of Yuhuangding Hospital,Yantai 264000,Shandong China 　　 　　【Abstract】 Objective To investgate the value of Fuji Intelligent Chromo Endoscopy(FICE) for the diagnosis of colonrectal neoplasia.Methods 781 patients were examined with ordinary colonoscopy from Janury in 2009 to February in 2010.236 patients with colon neoplasm or polypoid lesion were enrolled in this study.The patients were examined with magnifying conventional colonoscopy,magnifying FICE technique and magnifying chromoendoscopy technique,the pit pattern and blood capillary form of the lesion were examined.The endoscopic diagnosis was made,and compared with pathologic diagnosis.Results 431 neoplasms were detected in the 236 patients,among those 91.0%were detected with magnifying conventional endoscopy,97.9%were detected with FICE technique,there was significant difference between the two methods.FICE could more clearly show the structure and form of mucosal blood capillary than chromoendoscopy technique,(P 　　1.2 排除标准 ①炎症性肠病患者;②有家族大肠腺瘤病患者;③不能忍受内镜痛苦而未送达回盲部的患者;④确诊恶性肿瘤患者;⑤有肠镜检查禁忌证者。 　　1.3器械与试剂 所有患者均应用FujinonEC-590ZM型放大肠镜(日本富士能公司),染色剂0.4%靛胭脂。 　　1.4操作步骤 术前所有患者进镜前肌注山莨菪碱10 mg。服用和爽(复方聚乙二醇)清洁肠道。??查方法①常规模式进镜至末端回肠,退镜时发现黏膜异常后,放大观察腺管开口类型,评价是否为肿瘤,并记录大体形态;②转换至FICE模式观察病变形态边界,后放大观察病灶腺管开口及毛细血管形态,进行腺管开口分型及微血管分型;③用0.4%靛胭脂对病灶进行染色,观察病灶的大体范围及表面形态,后放大观察腺管开口形态,进行腺管开口分型;④对直径10 mm病变先行小探头超声检查,如病变在黏膜肌层内,行EMR或ERMR,如病变病理证实为癌且切缘见癌,追加外科手术。如内镜下诊断为癌的病变行多点活检,病理证实为癌,行外科手术。所有内镜切除标本及外科手术切除标本送检病理科,行连续切片、HE染色,由一