内镜碘染色在早期食管病变中的诊断价值

目的评价内镜下食管碘染色在诊断高危人群食管黏膜异型增生与早期食管癌诊断中的意义及应用价值。方法选择食管肿瘤高发区的高危人群,对其中内镜下的食管糜烂等病变116人,进行碘染色。根据染色后食管黏膜的颜色变化,可疑病灶进行有针对性地活检送病理检查。结果 116例患者食管黏膜碘染色后有不着色区或明显淡染区,病理显示85例为轻度不典型增生,15例为中度不典型增生,12例为重度不典型增生,早期食管癌4例。结论内镜下食管碘染色在早期食管癌及异型增生的诊断中敏感性高,漏诊率低,人群的顺应性较好,在食管高危人群的早期病变诊断中具有较高的应用价值。     

内镜下碘染色用于江苏淮安地区食管疾病筛查1983例研究

目的探讨内镜下碘染色在食管癌高发区的食管早癌内镜筛查中的重要临床价值。 方法2014至2016年在江苏省淮安市清浦区武墩镇及盐河镇等对1983例40～60岁人群进行食管癌内镜筛查,对比碘染色前后食管黏膜颜色和形态的变化,并对黏膜染色异常者行活检病理检查。 结果740例患者共835处病灶接受食管组织活检,有273例于碘染色前发现(白光状态下),碘染色后再发现562例。其中碘染后新发现5例黏膜内癌,205例各种异型增生,2组比较差异有统计学意义(P<0.05),表明碘染色后食管癌及癌前病变的检出率明显高于染色前。 结论内镜下食管黏膜碘染色可明显提高筛查过程中食管癌及癌前病变的检出率,且因其价格低廉,操作简单,值得临床推广应用。     

内镜下碘染色诊断早期食管癌的临床研究

目的 探讨内镜下碘染色对早期食管癌及癌前病变的诊断价值.方法 将内镜下有可疑食管病变的220例患者随机分为染色组和对照组各110例.用Lugol液对染色组进行食管黏膜染色检查,并对不染色和浅染色区进行病理活检.对照组不行Lugol液染色,仅根据临床经验进行病理活检.结果 染色组不着色或浅着色69例(62.7%),活检发现食管癌14例(12.7%),其中早期食管癌3例,鳞状上皮异型增生9例(8.1%);对照组110例活检发现食管癌2例(1.8%),轻中度异型增生4例(3.6%).两组食管癌诊断率的差异有统计学意义.结论 内镜下碘染色能减少食管黏膜活检误差,提高食管癌诊断率,有助于发现早期食管癌及其癌前病变.     

进展期食管癌全食管粘膜碘染色的作用

目的：观察全食管粘膜碘染色对进展期食管癌的诊断作用。方法：440例进展期食管癌行术前全食管粘膜碘染色检查，对不染、浅染、染色不均等染色异常区行粘膜活检，切除标本行次连续切片检查。结果：55例有染色异常，其中表现为主癌灶外另灶48例，主病灶范围较染色前内镜所见明显扩大7例。51例因染色发现更改了手术方式，由胸内吻合改为颈部吻合。术后病理结果，鳞癌46例，中、重度异型增生8例，1例碘染色异常术后标本病理结果正常。结论：全食管粘膜碘染色对进展期食管癌具有一定的应用价值，有助于发现同时存在的其他病灶及进一步确定病灶范围。     

内镜下碘染色对诊断食管癌及癌前病变的价值

[目的]探讨内镜下碘染色在诊断食管癌及癌前病变中的价值.[方法]在我市食管癌高发地区对239例40～69岁人群进行内镜下食管碘染色,观察食管黏膜染色情况,并取碘染异常区或贲门脊根部活检送病理组织学检查.[结果]239例接受内镜检查者其中有92例碘染色后出现不着色区或淡染区,病检示食管癌5例,检出率为2.09％,不典型增生病变46例（其中轻度不典型增生17,中重度不典型增生29例）,检出率为19.25％,慢性炎症33例,正常鳞状上皮8例.[结论]内镜下食管碘染色结合黏膜活检有助于早期食管癌及癌前病变的诊断,且操作简便,具有推广价值.     

内镜黏膜切除术在胃食管癌前病变治疗中的应用

目的 探讨内镜黏膜切除术在胃食管癌前病变治疗中的应用价值,并就适应证和操作方法等问题进行讨论.方法 选取内镜黏膜切除术后病理诊断为异型增生的49例患者,对手术前后病理结果进行对照,同时对手术并发症进行观察和处理.结果 切除病变56处,病变首次完全切除者52处(92.9%),术后病理诊断轻度异型增生7处,中度异型增生20处,重度异型增生29处.手术前后病理诊断相符者46处占82.1%,10处不相符的病变中有9处术前活检病理级别低于术后病理级别.并发症出血15例占30.6%,均经处理后停止出血,无一例发生穿孔.结论 对于术前活检病理为异型增生(即使为轻、中度异型增生)的病变均应积极行内镜黏膜切除治疗;内镜黏膜切除术是治疗胃食管癌前病变的有效方法,值得推广应用;术前黏膜染色和超声内镜检查对于病例的选择和手术安全性的判断具有重要意义.     

内镜窄带成像技术在早期胃癌及异型增生诊断中的应用

目的探讨内镜窄带成像技术（NBI）对早期胃癌及异型增生的诊断价值。方法217例普通胃镜和（或）NBI下表现异常者,依次采用普通放大、NBI结合放大、靛胭脂染色并放大观察,评价各检查方法图像的清晰度,并在NBI模式下于改变最显著部位活检行病理学检查。胃癌和重度异型增生者行内镜超声检查（EUS）,早期胃癌和重度异型增生者行内镜下治疗或手术治疗。结果在观察病变轮廓方面,NBI与染色内镜或普通内镜之间差异均有统计学意义,NBI最清晰,尤其是对于局灶性浅表性病变的观察;对于胃小凹的形态观察,NBI或染色内镜均优于普通内镜;在对胃黏膜微血管的观察中,NBI具有绝对优势。217例中发现轻度异型增生19例,中度异型增生9例,重度异型增生4例,早期胃癌5例。NBI模式下,胃小凹形态分为6种类型,异型增生主要表现为Ⅴ1型及Ⅳ型,早期胃癌主要表现为Ⅵ型。NBI放大内镜下3例早期胃癌可见新生或粗大血管,其中2例观察到螺旋形毛细血管。结论NBI技术操作简便,对胃黏膜病变轮廓显示清晰,放大后更可清晰观察到胃小凹及微血管形态,有助于提高早期胃癌及异型增生的靶向活检准确率。     

内镜染色指示下射频治疗食管不典型增生的研究

目的探讨内镜染色指示下射频消融术治疗食管不典型增生的疗效和安全性。方法对内镜检查发现食管有可疑病灶的病人用2%碘溶液食管染色后,在染色指示下多点取活检,经病理诊断为不典型增生,超声内镜检查病变局限于黏膜层者,在染色内镜直视下从病灶周围0.3~0.5cm处开始先射频点灼上下左右4点以标记切除范围,然后自病灶边缘向中心规律地射频消融治疗,功率为35W。每个接触部位治疗时间3~4s,使病灶及周围0.3~0.5cm以内黏膜及黏膜下层碳化为止。结果65例食管不典型增生(轻度18例,中度31例,重度16例)患者经1次染色内镜下射频消融治疗,随访6周~7年,所有病人痊愈,未发生出血、穿孔等并发症。结论射频消融术可作为阻断食管癌变发生发展的首选方法。     

内镜下双重色素法联合超声内镜对食管早期癌及癌前病变的诊断价值

目的:探讨美蓝和卢戈氏碘液双重染色法联合超声内镜对食管早期癌及癌前病变的诊断价值．方法:对96例可疑食管病变患者行食管黏膜染色,先用 20 g／L美蓝喷洒,再用30 g/L卢戈氏碘溶液喷洒于病变区观察;对美蓝染色区和卢戈氏碘不染色区进行活组织病理检查．食管癌及重度不典型增生、Barrett食管等癌前病变者再次行超声内镜检查．结果:确诊为食管癌7例,其中早期癌2例;不典型增生14例 (轻度7例,中度4例,重度3例);Barrett食管3例;溃疡8例;炎症36例．双重染色法总阳性率达70．8％．超声内镜对判断食管癌及癌前病变的浸润深度及纵隔淋巴结转移准确率达 92．3％(12／13)．结论:双重色素法(色素内镜)联合超声内镜有助于食管疾病,特别是早期癌及癌前病变的诊断,值得推广．     

卢戈液染色与P53蛋白检测诊断早期食管癌和癌前病变

目的 探讨内镜下卢戈液染色和活检组织P53检测诊断食管早期癌和癌前病变的可行性。方法 78例可疑早期食管癌患者行内镜下卢戈液染色,对粘膜不染色区活检结果为重度不典型增生细胞者行P53蛋白免疫组化染色,对P53蛋白阳性的病灶行内镜粘膜切除术。结果 在78例患者,共发现25例患者存在31处粘膜不染色区,其中单纯增生上皮1处,轻度异型增生2处,中度异型增生9处,重度异型增生16处,鳞状细胞癌3处。7例P53蛋白表达阳性的重度不典型增生粘膜行内镜粘膜切除术后,1例被证实为粘膜内癌。结论 卢戈液染色和活组织P53蛋白检测不仅对诊断早期食管癌有帮助,而且对选择治疗重度不典型增生病灶行内镜粘膜切除术有指导意义。     

三种模式内镜检查诊断早期食管癌及癌前病变的对比研究

目的通过白光模式、窄带成像技术（NBI）及卢戈染色方法对食管病变进行内镜观察,比较这3种模式诊断早期食管癌及癌前病变的临床应用价值。方法 2010年1月至2013年1月在南京医科大学第一附属医院消化内科均行白光模式、NBI模式及卢戈染色内镜检查共103例患者125个病灶,包括食管炎症病灶16个,轻、中、重度不典型增生病灶44、25、22个,早期食管癌病灶18个。对所有NBI阳性及卢戈染色阳性部位均取活检。以手术病理结果作为诊断金标准,3种模式对病变的检出率比较应用χ^2检验,病变NBI分级及卢戈染色分级与病理结果比较应用χ^2检验。结果 （1）103例患者内镜检查共发现125个病灶,其中白光模式下、NBI模式下及卢戈染色后分别发现早期食管癌及癌前病变85个（68.0%）、105个（84.0%）、109个（87.2%）;NBI模式下和卢戈染色对于早期食管癌及癌前病变的检出率差异无统计学意义,白光模式下早期食管癌及癌前病变的检出率均低于NBI模式下和卢戈染色后,且差异有统计学意义（χ^2=8.772,P=0.003;χ2=13.255,P=0.000）。（2）NBI模式下及卢戈染色诊断重度不典型增生和早期食管癌的敏感度均为100%（40/40）,均高于白光模式下的85.0%（34/40）,且差异均有统计学意义（χ2均=4.505,P均=0.026）;NBI模式下及卢戈染色诊断轻-中度不典型增生的敏感度分别为94.2%（65/69）、100%（69/69）,两者之间比较差异无统计学意义,但两者均高于白光模式下诊断轻-中度不典型增生的敏感度73.9%（51/69）,且差异均有统计学意义（χ2=10.599,P=0.001;χ^2=20.700,P=0.000）。重度不典型增生和早期食管癌病灶NBI分级、卢戈染色分级均多为Ⅰ级[90.0%（36/40）、95.0%（38/40）],轻-中度不典型增生病灶NBI分级、卢戈染色分级均多为Ⅱ、Ⅲ级[均为94.2%（65/69）],且差异均有统计学意义（χ^2=18.373、23.736、39.371、39.371,均P=0.000）。结论 NBI模式和卢戈染色均能够更清晰地显示早期食管癌及癌前病变的范围和大小,有助于更精确的活检,从而提高病变的检出率,且两者对于早期食管癌及癌前病变的诊断效能相似,均明显优于白光模式。NBI模式和卢戈染色可作为诊断早期食管癌的互补手段。     

Endoscopic mucosal resection for early esophageal cancer and esophageal dysplasia

BACKGROUND/AIMS: Advances in diagnostic technology have led to increased detection of early esophageal cancer, which is suitable for endoscopic treatment. We performed endoscopic esophageal mucosal resection of such cancer and dysplasia using the endoscopic esophageal mucosal resection tube and evaluated the clinical benefit of this technique. METHODOLOGY: Twenty-nine patients with esophageal mucosal cancer (27 cases with 33 lesions) or dysplasia (2 cases with 2 lesions) diagnosed between September 1992 and March 1998 were assessed endoscopically for the depth and extent of invasion by double staining with toluidine blue and iodine. Endoscopic ultrasonography was also performed to assess the depth of invasion in 22 cases with 22 lesions. RESULTS: The 35 esophageal lesions comprised 27 esophageal carcinomas and 8 areas of dysplasia. Twenty of the 35 lesions were resected en bloc and 15 were resected piecemeal. Subsequent surgery was performed for 5 cases with 7 lesions out of 10 cases with 15 lesions that were histopathologically diagnosed as m3 or more invasive. No recurrence has been detected in 24 evaluable cases (including 1 who died of another disease, 2 in whom surgery could not be performed due to complications, and 3 who refused subsequent surgery). No patients died of esophageal cancer after a mean follow-up period of 30.9 +/- 18.9 months. The 4-year survival rate was 100% in the m2 or less invasive group of 19 cases with 20 lesions, 75% in the m3 or higher invasive group of 5 cases with 8 lesions and 100% in the surgery group of 5 cases with 7 lesions (NS). No serious complications occurred except for 1 patient. Circumferential mucosal resection was done in this patient, resulting in esophageal stenosis, which responded to esophageal dilation. CONCLUSIONS: Esophageal mucosal resection using the endoscopic esophageal mucosal resection tube is safe and beneficial for early esophageal cancer and dysplasia.     

胃黏膜上皮细胞异型增生的随访研究

目的：探讨胃黏膜上皮细胞异型增生自然演变的规律及其在胃癌形成中的作用，为临床处理异型增生病灶提供依据和初步方法。方法：回顾性研究16年来50岁以上患者的胃镜检查结果，分析不同程度的异型增生的变化规律和可能的影响因素。结果：4354例患者共检出胃黏膜上皮细胞异型增生239例(261个病灶)，其中轻度异型增生119例(病灶131个)，中度异型增生77例(病灶83个)，重度异型增生43例(病灶47个)。异型增生病灶主要沿胃小弯侧分布。异型增生病灶外观各异，以局灶糜烂为最常见，133个(50．96％)，其次为局部充血50个(19．16％)，溃疡26个(9．96％)，正常黏膜外观24个(9．20％)。进行了完整随访的195例患者，轻度异型增生病变消失率最高，达86．36％，但也有8．18％检出胃癌；重度异型增生癌检出率最高，达72．09％，但也有23．26％发生了逆转，中度异型增生的消失率和癌检出率则居于前两者之间。轻度、中度、重度异型增生中癌检出率的相对危险度分别为1．96、3．74、17.25。结论：不同程度的异型增生均有一定的癌变能力，以重度异型增生的癌变率为最高。对不同程度的异型增生的处理上均要积极，同时也要注意区别对待。     

林州市食管癌和癌前病变检出率的群体对照研究

目的观察林州市高危人群中食管癌和癌前病变的检出率是否降低。方法根据1980年在林州市城郊乡内镜普查527例居民的性别和年龄构成,在同一人群中随机选择与之匹配的人群样本,进行内镜检查和活检病理组织学检查。结果958例受检人群中,检出食管癌、贲门癌32例,检出率3.34%。其中,食管早期表浅癌14例,进展期癌4例;贲门早期表浅癌10例,进展期癌4例。检出食管上皮异型增生91例,占9.50%。其中,轻度、中度和重度异型增生的检出率分别为7.72%、1.57%及0.21%。与1980年普查结果比较,癌和异型增生的检出率无明显差异（P〉0.05）。结论林州市城郊乡普查人群中,食管癌和癌前病变的检出率未见降低。     

卢戈液-美蓝双重染色在早期食管癌诊断中的价值

目的 提高早期食管癌的诊断水平。方法 先用卢戈液染色，再用美蓝染色，比较2次染色后食管病灶着色及范围，大致判断浸润深度，并用超声小探头观察病灶侵犯深度，采用内镜下黏膜切除术和手术治疗。结果 10例患者共11处癌灶，卢戈液染色后9处较好地显示了病灶范围，表现为正常食管黏膜染为棕色，病灶不着色；加用美蓝染色后，11处均清楚地显示了病灶，表现为正常黏膜不染色，病灶黏膜为水蓝色，边界清晰。1例行内镜下食管黏膜切除术切除，8例手术切除。病理结果均为鳞状细胞癌，其中黏膜癌6处，黏膜下癌4处，与其对照，胃镜和超声小探头鉴别黏膜癌和黏膜下癌的准确率均为80％，两者联合的准确率为90％。结论 卢戈液-美蓝染色较单一卢戈液染色，显示早期食管癌病灶及其范围更加清楚，可较准确地判断早期癌的侵犯深度。     

食管良性病变病理和预后的研究

目的探讨食管良性病变病理组织学类型和鳞癌及重度异型增生的发生率。方法对1997～2000年131例食管良性病变患者进行内镜形态观察与活检病理学检查,另取同期内镜检查食管正常者236例作为对照组。比较病理组织学变化,随访至2004年底,比较两组食管鳞癌和重度异型增生的发生率及相对危险度(RR)。结果食管良性病变根据内镜形态分为炎症糜烂型病变69例,平坦凹陷型病变21例和隆起型病变41例。病理组织学检查:正常或炎症上皮33例(25.19%),良性增生58例(44.27%)和轻中度异型增生40例(30.54%);对照组中,正常上皮181例(76.69%),良性增生55例(23.31%),无异型增生者。食管良性病变组中良性增生和轻中度异型增生明显高于对照组,而正常或炎症上皮明显低于对照组。食管良性病变组随访708人/年,鳞癌和重度异型增生分别发生21例和14例,共35例(4.94%)。对照组随访1315人/年,鳞癌和重度异型增生各发生1例,共2例(0.15%),食管良性病变组明显高于对照组。在食管良性病变中,良性增生和轻中度异型增生者鳞癌和重度异型增生发生率明显高于正常或炎症上皮。结论含有良性增生和轻中度异型增生的食管良性病变是食管鳞癌癌前状态。     

Endoscopic survey of esophageal cancer in a high-risk area of China

AIM: To characterize the histological types of esophageal and cardiac mucosa by endoscopic survey of a population in a high-risk area of esophageal cancer of China. METHODS: A selected cohort of residents in Cixian County during December 2001 and May 2002 was surveyed by using Lugol‘s staining, followed by computer-based statistical analysis of the data with SPSS 10.0 software. RESULTS: Histologically, the detection rates of squamous epithelial acanthosis, squamous epithelial atrophy, and basal cell hyperplasia in the esophagus were 1.9% (38/2013),0.1% (3/2013) and 0.9% (18/2013) respectively, and those of mild, moderate, and severe esophagitis were 34.9% (703/2013), 1.6% (33/2013) and 0.2% (2/2013) respectively. Mild, moderate, and severe esophageal dysplasia were detected in 8.6% (172/2013), 7.8% (157/2013) and 2.6% (53/2013) respectively in the selected population, whereas in situ carcinoma, intramucosal carcinoma, invasive squamous carcinoma of the esophagus in 2.5% (50/2013),0.2% (4/2013) and 0.7% (14/2013) respectively. The detection rates of non-atrophic gastritis and atrophic gastritis of the cardia were 36.3% (730/2013) and 11.5% (232/2013) respectively, with mild and severe dysplasia of the cardia detected in 2.5% (51/2013) and 0.8% (17/2013), respectively, in this population; the rates of intramucosal adenocarcinoma and invasive adenocarcinoma of the cardia were 0.1% (3/2013) and 0.8% (17/2013) respectively. The detection rate of esophageal cancer at early stage was 79.4% (54/68). The survey rate (ratio of examined population to expected population) was 73.8% (2013/2725). CONCLUSION: Histologic types of the esophageal and cardiac mucosa were characterized by endoscopic survey in a high-risk population of esophageal cancer, which may help the early detection and treatment of esophageal and cardiac cancers and dysplasia, and reduce the mortality of such malignancies.     

Endoscopic screening for early esophageal cancer by iodine staining in patients with other current or prior primary cancers

BACKGROUND: Although early diagnosis of esophageal carcinoma is an important determinant of outcome, early stage carcinomas are rarely detected on routine endoscopic examination. Iodine staining may be useful in the detection of early stage esophageal carcinoma, especially in high-risk populations. In a prior study, 29.2% (68/233) patients with superficial esophageal carcinoma (SEC) undergoing resection at our hospital had other nonesophageal primary carcinomas, suggesting that patients with nonesophageal primary cancers are at increased risk for the development of esophageal cancer. The aim of the current study was to determine whether endoscopic screening with iodine staining is useful for the detection of SEC in patients with a history of non-esophageal cancers. PATIENTS AND METHODS: In a prospective study, 331 patients with nonesophageal primary cancers were screened for esophageal cancer by endoscopic examination with iodine staining. All patients were men 55 years of age or older. RESULTS: Nine patients (2.7%) with SEC were identified. Among these patients, 7 with mucosal cancer were treated by endoscopic mucosal resection, and 2 with submucosal cancer were treated by surgical resection or radiation therapy. Five patients (1.5%) were found to have cancer confined to the epithelium or the lamina propria. These lesions were difficult to detect by conventional endoscopic screening and were cured by endoscopic mucosal resection. After exclusion of 51 patients with head and neck cancer, the incidence of SEC was still 2.1% (6/280), higher than reported in prior screening studies. CONCLUSIONS: All men with a history of nonesophageal primary cancers should undergo endoscopic screening for esophageal cancer. Endoscopic iodine staining in such patients may be useful in screening for early stage esophageal carcinoma.