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目的探讨放大内镜(magnifying endoscopy,ME)结合窄带成像技术(narrow-band imaging,NBI)靶向活检在早期胃癌诊断中的价值。方法普通白光胃镜检查发现可疑早期胃癌100例,均于2周后复查胃镜,采用ME-NBI技术对可疑部位进行重点观察,依据VS分类标准记录胃黏膜上皮下微血管、黏膜表面微形态,观察胃癌与周围黏膜间是否有分界线,于病变最明显处靶向活检,并行组织病理检查。结果根据VS分类标准,100例中规则微血管(regular microvessel,RV)+规则黏膜表面(regular microsurface,RS)23例,RV+不规则黏膜表面(irregular microsurface,IS)30例,RV+黏膜结构消失(absent microsurface,AS)6例,不规则微血管(irregular microvessel,IV)+RS 26例,IV+IS 2例,IV+AS 5例,微血管消失(absent microvessel,AV)+RS 6例,AV+IS 2例,AV+AS 0例;11例胃癌与周围黏膜间有分界线;ME-NBI技术靶向活检组织病理诊断非癌性病变79例(黏膜慢性炎症19例、单纯性萎缩性胃炎者20例、肠上皮化生24例、低级别上皮内瘤变16例),癌性病变21例(高级别上皮内瘤变10例、早期胃癌11例)。结论 ME-NBI技术可清晰观察病灶微细结构,结合VS分类标准,ME-NBI靶向活检在早期胃癌诊断中有重要价值。
Objective To investigate the value of magnifying endoscopy (ME) combined with narrow-band imaging (NBI) targeted biopsy in the diagnosis of early gastric cancer. Methods 100 cases of suspected early gastric cancer were found by plain white gastroscopy. Gastroscopy was performed after 2 weeks. The suspicious sites were mainly observed by ME-NBI technique. The gastric mucosal microvascular morphology and mucosal micro-morphology were recorded according to the VS classification criteria. And the surrounding mucosa whether there is a dividing line, the most obvious lesions in the target biopsy, parallel histopathological examination. Results According to the classification criteria of VS, 23 cases of regular microvessel (RV) + regular microsurface (RS), 30 cases of RV + irregular microsurface (IS), 100 cases of RV + mucosa disappeared 6 cases of irregular microvessel (IV) + RS, 2 cases of IV + IS, 5 cases of IV + AS, 6 cases of absent microvessel (AV) Cases, AV + AS 0 cases; 11 cases of gastric mucosa and the border between the line; ME-NBI technology targeted biopsy histopathological diagnosis of non-cancerous lesions in 79 cases (chronic mucosal inflammation in 19 cases, simple atrophic gastritis in 20 cases , 24 cases of intestinal metaplasia, 16 cases of low grade intraepithelial neoplasia), 21 cases of cancerous lesions (10 cases of high grade intraepithelial neoplasia and 11 cases of early gastric cancer). Conclusion The ME-NBI technique can clearly observe the fine structure of the lesion. Combined with the VS classification criteria, ME-NBI targeted biopsy is of great value in the diagnosis of early gastric cancer.