人工智能在上消化道内镜检查质量控制中的应用

食管癌及胃癌位列中国癌症发病率的前5位，大部分患者发现时即为中晚期，5年生存率较低，严重威胁患者的生命健康。食管癌和胃癌的早诊早治可明显降低患者的死亡率，提高生存率。内镜检查不仅是早期上消化道癌前病变及早期癌诊断的关键，而且还可完整切除病灶，达到治愈目的。伴随着食管癌及胃癌早诊早治理念的不断深入，进行胃镜诊疗的患者数量也在不断增加，但在应对检查例数增加的同时，缺乏有效的监测与监管及客观的评价，胃镜诊疗质量仍不容乐观。人工智能（artificial intelligence，AI）的出现将在胃镜检查中实时监测并提供智能预警，促进并监督内镜医师规范化操作，提高检查和操作质量。本文阐述了AI在胃镜质控中的应用进展和可能面临的问题。      

"食管癌早诊早治方案"的经济学评价

背景与目的：在中国,食管癌是死亡率位于前四位的恶性肿瘤之一,其5年生存率不足10％。食管癌的早期发现与治疗对提高患者生存率至关重要。本研究以近期在食管癌高发区河南省林州市开展的“食管癌早诊早治”的研究为背景,从成本效益角度对该食管癌筛查和早诊早治方案进行初步评价,以研究该方案带来的经济效益与社会效益。方法：采用分层抽样法对食管癌高发区河南省林州市3家医院136名食管癌住院或门诊患者进行问卷调查,同时对53名食管癌患者进行入户调查,以估算自然发生的食管癌“传统疗法”花费。以参加在该地开展的内镜筛查和早诊早治研究中的936人为背景,估算“食管癌早诊早治方案”的花费,对该方案进行成本效益分析和食管癌患者疾病经济负担研究。结果：食管癌“传统疗法”花费为人均7183元。参加内镜筛查的936人中,“食管癌早诊早治方案”的成本是148246元,效益是589006元,效益成本差为440760元,效益成本比率为4：1,患者治疗疾病的花费与家庭年总收入的比由1．300降为0．125。结论：“食管癌早诊早治方案”的成本低,效益好,且能降低食管癌患者的疾病经济负担。     

食管癌筛查和早诊早治的实践与经验

[目的]报告在高发区居民中食管癌筛查和早诊早治的效果和经验。[方法]分析2006—2008年在6个省中的8个县（市）居民中,开展食管癌筛查和早诊早治的资料。总结工作中的效果和经验。[结果]3年内镜检查共39221人,发现食管癌600例,检出率为1．53％。其中早期食管癌515例,早诊率85．83％。同时,发现胃贲门癌413例,检出率为1．05％。其中,早期贲门癌336例,贲门癌的早诊率81.36％。[结论]食管癌内镜筛查可发现大批早期癌和癌前病变,现阶段作为食管癌防治措施是可行的和有效的。     

河南食管癌高发区食管癌/贲门癌早诊早治项目实践与探索

[目的]总结探索在食管癌高发区实施食管癌/贲门癌早诊早治项目的效果和问题。[方法]分析2009～2010年林州、辉县、济源三市在40～69岁人群中,进行内镜食管贲门癌筛查资料,探讨适宜筛查人群和早诊早治效果。[结果]三市2009～2010年共筛查13071人,发现癌症病例369例,检出率2.82%,其中早期癌323例,早诊率87.53%。林州272例治疗患者治疗率为64.34%。[结论]在食管癌高发区高危人群中,开展内镜筛查实施早诊早治是可行的,将筛查人群定为40～74岁年龄组可能更有意义。     

贲门癌筛查和早诊早治的经验

[目的]总结在食管癌高发区居民中贲门癌筛查和早诊早治的效果和经验。[方法]分析2006～2009年在7个省的9个县(市)居民中,开展内镜筛查贲门癌和早诊早治的资料,包括筛查结果和经验,特别是总结贲门癌高发位点的发现对贲门癌早期诊断的贡献。[结果]4年内镜筛查共53911人,发现贲门癌524例(包括癌前病变),检出率为0.97%。其中早期癌416例,早诊率为79.4%。[结论]内镜筛查可发现大量贲门癌和癌前病变,现阶段作为贲门癌防治措施是可行的和成功的。     

甘肃省食管癌/贲门癌筛查初步报告

[目的]探讨甘肃省食管癌/贲门癌筛查情况。[方法]采用整群抽样的方法,选取甘肃省食管癌/贲门癌发病率和死亡率较高的目标人群,开展流行病学调查、内镜检查辅助食管碘染色和指示性活检。[结果]2009年甘肃省食管癌和贲门癌早诊早治两个项目点实际筛查2050人,查出早期食管癌1例,浸润癌11例,食管癌早诊率为8.3%;贲门癌病例10例,早诊病例7例,早诊率达70.0%。[结论]甘肃省食管癌/贲门癌早诊早治项目初步形成项目运作模式,还需在全省内开展。     

2005～2010年磁县食管癌早诊早治内镜普查工作总结

[目的]探索一条科学的筛查工作方法及可持续发展食管癌防治新模式,降低内镜检查的风险,防止并发症的发生,提高普查顺应性和阳性率。[方法]按照磁县食管癌早诊早治普查工作流程和国家《食管癌早诊早治项目技术方案》,应用电子内镜检查加碘染色加多点指示性活检技术,对2005~2010年40~69岁人群共10914例食管癌普查。[结果]活检10291例,活检率94.29%,严重并发症发生率为0.12%。普查顺应性约为60%。并发症35例,其中出血13例,咽喉损伤10例,肠痉挛5例,下颌关节脱臼5例,碘过敏1例,唾液腺肿胀1例。[结论]建立一支技术过硬的食管癌早诊早治普查队伍,按照食管癌早诊早治普查工作流程,遵守国家《食管癌早诊早治项目技术方案》可有效地降低内镜检查的并发症,提高普查顺应性和阳性率。     

食管癌早诊早治普查顺应性的影响因素分析

[目的]探讨影响食管癌早诊早治普查顺应性的因素。[方法]分析2005~2010年磁县食管癌早诊早治胃镜普查中影响顺应性的因素。[结果]2005~2010年磁县食管癌早诊早治胃镜普查顺应性明显提高。抓住普查时机、消除社会恐惧心理、行政干预、强化舒适内镜概念为提高普查顺应性要素。[结论]进一步做好宣传发动工作,抓住普查时机,强化舒适内镜概念是提高顺应性的关键。     

在食管癌高危人群中进行早诊早治的认知调查

目的　了解太行山区食管癌高危人群对食管癌的认知程度 ,探讨在该地区开展食管癌早诊早治在社会心理上的可行性。方法　采用横断面调查方式 ,对太行山区 10 48个食管癌高危对象以食管癌认知问卷调查其对食管癌的认知及对早诊早治的倾向。结果　研究 4个村 40～ 6 9周岁共 16 75人 ,其食管癌筛查接受率为 5 7.6 %。92 .8%被调查者本来不知道食管癌早期阶段。 6 6 .5 %的参加筛查者自费亦愿参加食管癌筛查 ;如有适于镜下治疗的早期病变 ,96 .3%参加筛查者愿进行早期治疗。结论　太行山区食管癌高危人群对食管癌早期阶段认知程度尚低 ,但该地区的大部分高危人群愿意接受食管癌早诊早治 ,在该高发区开展食管癌二级预防具备社会心理上的可行性。     

四川省食管癌早诊早治效果评价

[目的]评价食管癌高发区早诊早治项目筛查人群食管癌及癌前病变的患病情况。[方法]在四川省食管癌高发地区,采取整群随机抽样的方法选择至少一个乡或村作为筛查对象,对40~69岁人群采取内镜下碘染色及指示性活检技术进行筛查,并行病理学诊断。[结果]全省合计筛查11021人,筛查率100.19%;重度异形增生/原位癌及以上病人检出168例,检出率为1.53%;其中食管癌61例,检出率为0.55%。全省早诊率67.86%;治疗率67.26%。[结论]在食管癌高发区人群中存在着一定数量的无明显临床症状的癌前病变及早期食管癌患者,对该部分高危人群进行食管癌普查并进行癌症综合知识宣传,提高其防癌意识,是提高早期食管癌检出率,做好食管癌二级预防工作的关键。     

Endoscopic Diagnosis and Treatment of Superficial Esophageal Squamous Cell Cancer: Present Status and Future Perspectives

This review provides information regarding the preoperative examinations, indications for endoscopic resection (ER), and curability assessment in subjects with superficial esophageal squamous cell carcinoma (SCC). Narrow-band imaging (NBI) is a more sensitive modality for detecting esophageal cancer than conventional observation, and esophageal observation using NBI is thus recommended for the detection of superficial esophageal cancer. It is also important to adjust the volume of air in the esophagus during observation. Workup by non-magnifying followed by magnifying endoscopy is a common process for diagnosing the invasion depth of superficial esophageal SCCs in Japan. Endoscopic ultrasonography carries a risk of overdiagnosis, and its routine use is therefore not recommended. The Japanese endoscopic submucosal dissection/endoscopic mucosal resection guidelines for esophageal cancer considered the indications for ER based on the results of studies focusing on clinical MM/SM1 cancers, and concluded that clinical MM/SM1 carcinomas, except circumferential carcinoma, were an indication for ER. The curative effect of ER should be assessed based on histologic examination of the resected specimens. ER should be conducted based on a thorough understanding of the preoperative diagnosis, indication, curability, and additional treatment of esophageal SCC.     

Treatment of esophageal cancer in elderly patients

During the last 30 years, the median survival time and 5-year survival rate of esophageal cancer have improved significantly. In recent years, two major factors have greatly contributed to improve the outcomes of treatment for esophageal cancer in Japan. One is the establishment of endoscopic diagnosis and treatment of superficial esophageal cancer, and another is the establishment of a standard surgical procedure, subtotal esophagectomy with dissection of three field lymph nodes. In an aging society like Japan, with the increased incidence, the diagnosis and treatment of esophageal cancer will become increasingly important in the future. The effectiveness and risk of surgical treatment, chemotherapy, radiotherapy and combination therapy for elderly patients with esophageal cancer will also become important. However, the average life expectancy has reached 79 years for Japanese men, and various evidence from clinical research on patients less than 75 years old is not longer sufficient. Care of elderly patients with esophageal cancer has relied on past experience. Now, clinical studies on elderly esophageal cancer must be improved.     

人工智能在内镜诊断上消化道早癌领域的研究进展

随着深度学习算法的不断开发,人工智能在内镜辅助诊断中的应用也备受关注。上消化道肿瘤因其早期不易被发现的特点成为内镜医师镜下诊断的难题,而计算机辅助诊断等新技术有望实现对上消化道早期恶性病变及其相关危险因素的识别及诊断。本文阐述了目前人工智能在内镜诊断上消化道早癌领域的应用情况和发展前景。     

人工智能在鼻咽癌诊断与预后领域的研究进展

人工智能（artificial intelligence,AI）的应用可以帮助解决鼻咽癌（nasopharyngeal carcinoma,NPC）诊断中的诸多问题,包括影像学诊断、病理学诊断、内镜筛查等,并可以通过AI对鼻咽癌患者达到预测预后的目的。就目前而言,虽然AI在鼻咽癌领域的应用越来越多,但是AI在实际应用方面仍面临较多挑战。相信随着AI在鼻咽癌领域的应用增加与不断改进的算法,未来AI能作为常用的工具应用于临床。     

Diagnosis and Treatment of Esophageal Neoplasms

During the last 10 years, the diagnosis and treatment of esophageal carcinoma have improved considerably. Endoscopy with Lugol staining and endoscopic ultrasonography have been newly introduced and used for early diagnosis and more accurate tumor staging. As a result, the number of patients with tumors at an early stage has increased remarkably (superficial carcinoma, 23%). In the field of treatment, surgical results have improved not only in the short term (30-day mortality rate, 4%) but also in the long term (5-year survival rate, 30%). The field of operation has been extended (3-fieId lymph node dissection), with lower morbidity and mortality. On the other hand, some techniques for limited treatment such as endoscopic mucosal resection, intraluminal radiotherapy, and laser irradiation have been introduced for the treatment of esophageal carcinoma at an early stage with curative intent. However, there are still many patients with esophageal carcinoma at an advanced stage for whom these treatments fail or are futile. The role of radiotherapy has been made more significant by the introduction of brachytherapy or in combination with other treatment modalities such as surgery, chemotherapy and hyperthermia. Response rates for existing anticancer drugs used as a single agent are 0-38%. Chemotherapy appears to have created significant improvements when used in combined modalities (response rate, 16-76%). However, chemotherapy for patients with esophageal carcinoma still offers an unsatisfactory survival benefit and remains experimental. Studies to evaluate multimodality treatments using chemotherapy, combined with radiotherapy and/or surgery have started. The contribution of molecular biology to the diagnosis and treatment of this disease is a subject for future investigation.     

Endoscopic treatment of esophageal cancer]

With the advance of endoscopic equipment the number of superficial cases of esophageal cancer has been increasing dramatically. It has been clarified as to which cancer can be treated as an early cancer with desirable results as in gastric cases. Endoscopic treatment for early cancer already established in gastric or colorectal cases have been applied to esophageal cases with nationwide popularity. Especially endoscopic mucosal resection, which can assure accurate pathological findings, can be the treatment of choice for endoscopic procedures for early cancer. In this paper, our methodology of endoscopic treatment of early esophageal cancer is introduced and our endoscopic approach to advanced cases which is still to be established is reported.     

超声内镜对消化道早期癌的诊断价值

目的：探讨超声内镜对消化道早期癌的临床诊断价值。方法对90例消化道早期癌患者的内镜检查及临床资料进行回顾性分析,以术后病理诊断为标准,探讨超声内镜对消化道肿瘤的临床早期诊断及分型诊断价值。结果超声内镜检查对食管癌、胃癌和结直肠癌的临床诊断的准确率为85．3％、88．9％、86．2％,均明显高于常规内镜检查结果。超声内镜对早期食管癌分型结果与术后病理学检查证实的符合率为85．3％（29／34）;其对早期胃癌的分型诊断结果表明早期胃癌以浅凹陷（Ⅱc）为主（40．7％）,浸润深度以黏膜内癌为主（63．0％）,组织学以低分化腺癌较多（74．1％）;与病理学分期诊断比较,超声内镜对29例早期结直肠癌患者的诊断准确为72．4％（21／29）。结论超声内镜对消化道早期癌的诊断价值较高,对其临床指导治疗具有重要的意义,值得进一步推广和应用。     

内镜下黏膜剥离术治疗早期食管癌及癌前病变的临床应用

目的探讨内镜黏膜剥离术（ESD）在早期食管癌及癌前病变治疗中的应用价值与意义。方法选取2007年1月至2010年1月57例行内镜检查取活检经病理学确诊的早期食管癌及癌前病变并行ESD治疗的患者,进行内镜下黏膜剥离术,对照术前与术后的病理结果,并对手术并发症、治疗效果及预后进行观察。结果57例行ESD治疗的早期食管癌及癌前病变患者,术后病理学诊断黏膜内癌12例（21．1％）,原位癌22例（38．6％）,重度不典型增生18例（31．6％）,中度不典型增生5例（8．8％）。术前术后病理学诊断符合率为87．6％,其中有10例不相符的患者为术前活检病理级别低于术后病理级别。结论对于病理学活检、染色内镜及超声内镜确诊为直径〈30mm无肿瘤转移的早期食管癌及中重度异型增生患者进行内镜下黏膜切除术效果良好。黏膜下剥离术是这类早期食管癌及癌前病变治疗的有效方法,且创伤小,能有效提高患者术后生活质量,值得临床推广应用。     

Esophageal cancer: A Review of epidemiology,pathogenesis, staging workup and treatment modalities

Esophageal cancer is a serious malignancy with regards to mortality and prognosis. It is a growing health concern that is expected to increase in incidence over the next 10 years. Squamous cell carcinoma is the most common histological type of esophageal cancer worldwide, with a higher incidence in developing nations. With the increased prevalence of gastroesophageal reflux disease and obesity in developed nations, the incidence of esophageal adenocarcinoma has dramatically increased in the past 40 years. Esophageal cancer is staged according to the widely accepted TNM system. Staging plays an integral part in guiding stage specific treatment protocols and has a great impact on overall survival. Common imaging modalities used in staging include computed tomography, endoscopic ultrasound and positron emission tomography scans. Current treatment options include multimodality therapy mainstays of current treatment include surgery, radiation and chemotherapy. Tumor markers of esophageal cancer are an advancing area of research that could potentially lead to earlier diagnosis as well as playing a part in assessing tumor response to therapy.