内镜窄带成像技术对早期喉癌及癌前病变的鉴别诊断价值

程景炜　叶远航　吴伟军　曾艳玲

摘要： 目的：探讨内镜窄带成像技术（NBI）诊断早期喉癌及癌前病变的临床应用价值。方法：选取自2018年1月至2019年12月就诊于我院耳鼻咽喉科门诊，经电子鼻咽喉镜筛查发现喉肿物及疑似恶性病变，需取活检明确诊断的患者76例;所有患者按单双日随机分为白光模式组31例（白光模式下行喉肿物活检）和NBI模式组45例（NBI模式下行喉部肿物活检），两组患者均根据活检病理结果行相应的外科手术，并将手术切除组织送病理检查，将其病理学结果作为金标准。分别计算两组恶性病变活检检出率及活检正确检出率，并作统计分析。结果：白光模式组恶性肿瘤活检检出率为68.42%，NBI模式组为95.83%，两组间比较有显著性差异（x2=4.0085，P<0.05）;白光模式组活检正确检出率为67.74%，NBI模式組为88.89%，两组间比较有显著性差异（x2=5.1816，P<0.05）。结论：内镜窄带成像技术能显著提高喉恶性肿瘤的活检检出率及正确检出率，减少漏诊和误诊，在喉癌的早期诊断中起到重要的作用。

关键词：喉肿瘤;喉镜检查;内镜窄带成像技术;活体组织检查

【中图分类号】R715      【文献标识码】A       【文章编号】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.

综上所述，NBI作为一种新型的无创性内镜下成像诊断技术，通过识别异常IPCL，有助于临床医生预判病变的性质、部位及浸润范围，提高活检阳性率，减少漏诊和误诊，为靶向活检提供一种新途径。然而，NBI内镜技术尚未能形成较为精确的、国际公认的诊断标准及本研究仅获得了一些初步结论，病例种类、数量还不够丰富，存在一定的抽样误差，仍需继续总结NBI模式下喉癌的诊断经验，以期提高喉癌早期诊断率。

参考文献

[1] 黄选兆，汪吉宝，等.实用耳鼻咽喉科学：人民卫生出版社， 2006， 7（1）： 503.

[2]  中华耳鼻咽喉头颈外科杂志编辑委员会头颈外科组，中华医学会耳鼻咽喉头颈外科学分会头颈学组.喉癌外科手术及综合治疗专家共识.中华耳鼻咽喉头颈外科杂志，2014，49（8）：620-626.

[3] Kumagai Y，Toi M，Inoue H.Dynamism of tumour vasculature in the early phase of cancer progression：outcomes from oesophageal cancer research[J].Lancet Oncol，2002，3（10）：604-610.

[4] 倪晓光，贺舜，徐震纲，等.窄带成像内镜在喉癌诊断中的应用[J].中华耳鼻咽喉头颈外科杂志，2010，45（2）：143-147.

[5] Kraft M， Fostiropoulos K， Gürtler N， et al. Value of narrow band imaging in the early diagnosis of laryngeal cancer[J]. Head Neck，2016， 38（1）： 15-20.

[6] 许丽萍，刘吉祥.窄带成像技术普通内镜对喉恶性病变的诊断价值[J].中国耳鼻咽喉头颈外科，2016，23（1）：23-26.

[7] 陈志鹏，熊姗姗，陈粉珊，等.窄带成像技术在咽喉部肿瘤早期诊断中的应用[J].临床耳鼻咽喉头颈外科杂志，2016，30（4）：264-267.

[8] 岳振忠，张永兰，王桂萍，等.窄带成像技术在喉部肿瘤中应用的探讨[J].临床耳鼻咽喉头颈外科杂志，2017，31（6）：428-430.

[9] 杨笑怡，王林，刘吉祥.窄带成像内镜在喉部恶性病变活检中的应用[J].中华耳鼻咽喉头颈外科杂志， 2014，49（8）：627-631.

[10] Volgger V， Felicio A， Lohscheller J， et al. Evaluation of the combined use of narrow band imaging and high-speed imaging to discriminate laryngeal lesions[J]. Lasers Surg Med， 2017， 49（6）：609-618.

[11] De Vito A， Meccariello G， Vicini C. Narrow band imaging as screening test for early detection of laryngeal cancer： a prospective study[J]. Clin Otolaryngol， 2017， 42（2）： 347-353.

[12] Ho CY，Lee YL，Chu PY.Use of narrow band imaging in evalu-ation of possible nasopharyngea1 carcinoma[J].Am J Rhinol Allergy，2011，25：107.

作者简介：程景炜（198409-），硕士，主治医师，研究方向：嗓音鼾症专科。

通讯作者简介：叶远航（197704-） 碩士 副教授。

课题资助：梅州市医药卫生科研立项课题（2019-B-33）