窄带成像内镜下结直肠息肉形态特征差异及对息肉性质的鉴别价值

doi:10.3969/j.issn.1006-6233.2024.01.025

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摘要 目的: 窄带成像内镜(NBI)下的结直肠息肉形态特征差异及其对息肉性质的鉴别诊断价值。方法: 选取齐齐哈尔市第一医院2021年2月至2023年2月接受结直肠内镜检查且确诊为结直肠息肉样病变患者126例(768颗息肉)作为研究对象,统计分析检出息肉的大小、形态、表面黏膜情况,根据病理学结果将息肉分为非瘤性息肉和癌前病变息肉,并计算NICE分型判别息肉性质的价值,并绘制ROC曲线。结果: 高级别上皮瘤变息肉中直径≥1.0cm的息肉占比显著高于管状腺瘤、炎性息肉、炎性息肉(P值均<0.003),管状绒毛状腺瘤中直径≥1.0cm的息肉占比显著大于炎性息肉、增生性息肉(P值均<0.003);管状绒毛状腺瘤中直径≥1.0cm的息肉占比显著大于炎性息肉(P<0.003);高级别上皮瘤变息肉的山田分型与绒毛状腺瘤、增生性息肉的山田分型比较,差异具有统计学意义(P值均<0.003);绒毛状腺瘤中分叶状息肉占比显著高于管状腺瘤、高级别上皮瘤变、炎性息肉、管状绒毛状腺瘤、增生性息肉(P值均<0.003);管状腺瘤、炎性息肉、管状绒毛状腺瘤、增生性息肉黏膜表面光滑的占比率显著高于绒毛状腺瘤、高级别上皮瘤变(P值均<0.003);NICE分型标准判断结直肠息肉瘤性或非瘤性息肉的灵敏度为88.62%、特异度为90.94%、漏诊率为11.38%、误诊率为9.06%。结论: 在NBI下,不同病理学类型的结直肠息肉形态特征、大小、表面黏膜特征相比较有显著差异,且NBI检查对于鉴别诊断结直肠息肉性质具有较高的临床应用价值。

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关键词 ：窄带成像内镜, 结直肠息肉, 鉴别诊断

Abstract：Objective: To investigate the morphological differences of colorectal polyps under Narrow Band Imaging (NBI) endoscopy and evaluate their diagnostic value in distinguishing the nature of polyps. Methods: A total of 126 patients (768 polyps) diagnosed with colorectal polyp-like lesions during colonoscopy from February 2021 to February 2023 at the First Hospital of Qiqihar were included. The size, morphology, and surface mucosa of polyps were analyzed. Polyps were classified into non-neoplastic polyps and adenomas based on pathological results. The diagnostic value of the NICE classification in determining polyp nature was calculated, and ROC curves were plotted. Results: The proportion of polyps with a diameter ≥1.0 cm in high-grade epithelial dysplasia adenomas was significantly higher than in tubular adenomas, inflammatory polyps, and hyperplastic polyps (P<0.003). The proportion of polyps with a diameter ≥1.0 cm in tubular-villous adenomas was significantly higher than in inflammatory polyps and hyperplastic polyps (P<0.003). The proportion of polyps with a diameter ≥1.0 cm in tubular-villous adenomas was significantly higher than in inflammatory polyps (P<0.003). The Yamada classification of high-grade epithelial dysplasia adenomas differed significantly from that of villous adenomas and hyperplastic polyps (P<0.003). The proportion of lobulated polyps in villous adenomas was significantly higher than in tubular adenomas, high-grade epithelial dysplasia adenomas, inflammatory polyps, tubular-villous adenomas, and hyperplastic polyps (P<0.003). The percentage of polyps with smooth mucosal surfaces in tubular adenomas, inflammatory polyps, tubular-villous adenomas, and hyperplastic polyps was significantly higher than in villous adenomas and high-grade epithelial dysplasia adenomas (P<0.003). The sensitivity, specificity, missed diagnosis rate, and misdiagnosis rate of NICE classification in determining the nature of colorectal polyps were 88.62%, 90.94%, 11.38%, and 9.06%, respectively. Conclusion: Under NBI, there are significant differences in the morphological characteristics, size and surface mucosal characteristics of colorectal polyps in different pathological types, and NBI examination has a high clinical application value in the differential diagnosis of colorectal polyps.

Key words： Narrowband imaging endoscopy Colorectal polyps Differential diagnosis

基金资助:黑龙江省卫生健康委科研课题,(编号:2019-265)

引用本文:

蔡萍, 宋治, 杨茜, 刘亚芳, 王莹, 申龙飞. 窄带成像内镜下结直肠息肉形态特征差异及对息肉性质的鉴别价值[J]. 河北医学, 2024, 30(1): 124-129.
CAI Ping, SONG Zhi, YANG Qian, et al. Morphological Differences of Colorectal Polyps Under NBI Endoscopy and Their Diagnostic Value in Polyp Characterization. HeBei Med, 2024, 30(1): 124-129.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2024.01.025 或 http://www.hbyxzzs.cn/CN/Y2024/V30/I1/124

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