內(nèi)鏡窄帶成像技術(shù)對早期喉癌及癌前病變的鑒別診斷價值

程景煒　葉遠航　吳偉軍　曾艷玲

摘要： 目的：探討內(nèi)鏡窄帶成像技術(shù)（NBI）診斷早期喉癌及癌前病變的臨床應(yīng)用價值。方法：選取自2018年1月至2019年12月就診于我院耳鼻咽喉科門診，經(jīng)電子鼻咽喉鏡篩查發(fā)現(xiàn)喉腫物及疑似惡性病變，需取活檢明確診斷的患者76例;所有患者按單雙日隨機分為白光模式組31例（白光模式下行喉腫物活檢）和NBI模式組45例（NBI模式下行喉部腫物活檢），兩組患者均根據(jù)活檢病理結(jié)果行相應(yīng)的外科手術(shù)，并將手術(shù)切除組織送病理檢查，將其病理學結(jié)果作為金標準。分別計算兩組惡性病變活檢檢出率及活檢正確檢出率，并作統(tǒng)計分析。結(jié)果：白光模式組惡性腫瘤活檢檢出率為68.42%，NBI模式組為95.83%，兩組間比較有顯著性差異（x2=4.0085，P<0.05）;白光模式組活檢正確檢出率為67.74%，NBI模式組為88.89%，兩組間比較有顯著性差異（x2=5.1816，P<0.05）。結(jié)論：內(nèi)鏡窄帶成像技術(shù)能顯著提高喉惡性腫瘤的活檢檢出率及正確檢出率，減少漏診和誤診，在喉癌的早期診斷中起到重要的作用。

關(guān)鍵詞：喉腫瘤;喉鏡檢查;內(nèi)鏡窄帶成像技術(shù);活體組織檢查

【中圖分類號】R715 ???? 【文獻標識碼】A ? ????【文章編號】1004-7484（2019）10-0187-02

The value of endoscopic narrowband imaging in the differential diagnosis

of early laryngeal cancer and precancerous lesions

【Abstract】Objective：To explore the clinical value of endoscopic narrowband imaging in the diagnosis of early laryngeal cancer and precancerous lesions.Methods：76 patients who were admitted to the otolaryngology department of our hospital from January2018 to December 2019 and were found to have laryngeal masses and suspected malignant lesions through electronic rhinolaryngology screening and needed biopsy for definite diagnosis were selected. The patients were divided into two groups according to the single-day and dual-day random method： 31 cases of the white light mode group and 45cases of the NBI model group，the laryngeal mass was biopsied respectively in white light mode and NBI model group. Patients in both groups underwent corresponding surgical operations according to the biopsy results， the surgically removed tissue was sent for pathological examination， and the pathological results were taken as the gold standard. The positive rate of malignant tumors and accurate rate of biopsy in the two groups were calculated and statistically analyzed.Results：The positive rate of malignant tumors in the white light mode group was 68.42%， and that in the NBI mode group was 95.83%，indicating a significant difference between the two groups （x2=4.0085，P<0.05）.The accurate rate of biopsy in the white light mode group was 67.74%， while that in the NBI mode group was 88.89%， indicating a significant difference between the two groups（x2=5.1816，P<0.05）.Conclusion： Endoscopic narrowband imaging technology can significantly improve the positive rate of laryngeal malignant tumor and accurate rate of biopsy， reduces missed diagnosis and misdiagnosis， plays an important role in the early diagnosis of laryngeal cancer.

綜上所述，NBI作為一種新型的無創(chuàng)性內(nèi)鏡下成像診斷技術(shù)，通過識別異常IPCL，有助于臨床醫(yī)生預(yù)判病變的性質(zhì)、部位及浸潤范圍，提高活檢陽性率，減少漏診和誤診，為靶向活檢提供一種新途徑。然而，NBI內(nèi)鏡技術(shù)尚未能形成較為精確的、國際公認的診斷標準及本研究僅獲得了一些初步結(jié)論，病例種類、數(shù)量還不夠豐富，存在一定的抽樣誤差，仍需繼續(xù)總結(jié)NBI模式下喉癌的診斷經(jīng)驗，以期提高喉癌早期診斷率。

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作者簡介：程景煒（198409-），碩士，主治醫(yī)師，研究方向：嗓音鼾癥?？啤?/p>

通訊作者簡介：葉遠航（197704-） 碩士 副教授。

課題資助：梅州市醫(yī)藥衛(wèi)生科研立項課題（2019-B-33）