幽门螺杆菌根治性治疗对早期癌症内镜诊断的影响

中华消化内镜杂志 Pub Date : 2019-12-20 DOI:10.3760/CMA.J.ISSN.1007-5232.2019.12.008

Jianqi Li, Menghua Cheng, Wen-xia Chen, Hongyu Ren, Jun Liu

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引用次数: 0

摘要

目的探讨幽门螺杆菌（HP）根治性治疗对早期癌症诊断的影响。方法采用常规白光内窥镜（WLE）、醋酸添加靛蓝胭脂红染色染色内窥镜和窄带成像放大内窥镜。方法2013年1月至2018年3月，在鄂州医院消化内科、武汉大学人民医院或协和医院消化内科接受内镜检查的无HP（6个月内成功治愈）或HP（近6个月无HP根治性治疗）患者，华中科技大学同济医学院参与了这项研究。根据常规WLE、使用添加到乙酸中的靛蓝胭脂红染料的彩色内窥镜和ME-NBI的顺序进行内窥镜检查。在组织病理学最终诊断为早期癌症的患者中，连续收集120例无HP患者和120例HP患者，分别纳入根治性治疗组和非根治性治疗小组。对两组早期癌症的WLE、彩色内窥镜检查和ME-NBI诊断的可靠性进行统计学分析。结果两组患者的医院来源、性别构成、平均年龄（t=0.582，P=0.561）、病变形态（t=0.179，P=0.914）差异无统计学意义，染色内窥镜检查[57.5%（69/120）VS 93.3%（112/120），χ2=41.554，P<0.001]和ME-NBI[90.0%（108/120）VS98.3%（118/120）、χ2=7.585，P=0.006]均显著低于非根治性治疗组。在根治性治疗组中，早期胃癌癌症的彩色内镜检出率最低，其次是WLE（X~2=2.142，P=0.143）和ME-NBI（X~2=32.336，P＜0.001），而早期癌症的ME-NBI检出率最高，高于WLE（C~2=19.247，P＜0.01），在HP的根治性治疗后，使用添加到乙酸和ME-NBI中的靛蓝胭脂红染料的染色内窥镜检查变得更加困难。在上述三种内镜方法中，ME-NBI的诊断效果最高，成为HP根治性治疗后早期癌症临床诊断的首选。关键词：幽门螺杆菌；早期癌症；白光内窥镜检查；染色内窥镜检查；窄带成像放大内窥镜

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Effects of radical treatment of Helicobacter pylori on endoscopic diagnosis of early gastric cancer

Objective To investigate the effects of Helicobacter pylori (HP) radical treatment on diagnosis of early gastric cancer using conventional white light endoscopy (WLE), chromoendoscopy of indigo carmine dye added to acetic acid, and magnifying endoscopy with narrow band imaging (ME-NBI). Methods Between January 2013 and March 2018, patients without HP (successful cured before six months) or with HP (no radical treatment for HP in recent 6 months), who underwent endoscopy examinations in the Department of Gastroenterology of Ezhou Hospital, People′s Hospital of Wuhan University or the Department of Gastroenterology of Union Hospital, Tongji Medical College Huazhong University of Science and Technology were enrolled in the study. Endoscopy examinations were performed according to the order of conventional WLE, chromoendoscopy using indigo carmine dye added to acetic acid, and ME-NBI. Among the patients finally diagnosed as early gastric cancer by histopathology, 120 patients without HP and 120 patients with HP were continuously collected, and included in the radical treatment group and the non-radical treatment group, respectively. Diagnostic reliabilities of WLE, chromoendoscopy, and ME-NBI for early gastric cancer between the two groups were statistically analyzed. Results There were no statistical differences between the two groups in terms of hospital source (χ2=2.637, P=0.104), gender composition (χ2=0.074, P=0.785), mean age (t=0.582, P=0.561), and lesion morphology (χ2=0.179, P=0.914). The detection rates of early gastric cancer in the radical treatment group using WLE [75.0% (80/120) VS 81.7% (98/120), χ2=7.046, P=0.008], chromoendoscopy [57.5% (69/120) VS 93.3% (112/120), χ2=41.554, P<0.001], and ME-NBI [90.0% (108/120) VS 98.3% (118/120), χ2=7.585, P=0.006] were significantly lower than those in the non-radical treatment group. In the radical treatment group, chromoendoscopy had the lowest detection rate of early gastric cancer, followed by WLE (χ2=2.142, P=0.143) and ME-NBI (χ2=32.736, P<0.001), while ME-NBI had the highest detection rate of early gastric cancer, which higher than that of WLE (χ2= 19.247, P<0.001). Conclusion The diagnosis of early gastric cancer by WLE, chromoendoscopy using the indigo carmine dye added to acetic acid and ME-NBI becomes more difficult after radical treatment of HP. Among the above three endoscopic methods, ME-NBI has the highest diagnostic efficacy, and becomes the first choice for the clinical diagnosis of early gastric cancer after radical treatment of HP. Key words: Helicobacter pylori; Early gastric cancer; White light endoscopy; Chromoendoscopy; Magnifying endoscopy with narrow band imaging

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来源期刊

中华消化内镜杂志

CiteScore

0.10

自引率

0.00%

发文量

7555

期刊介绍： Chinese Journal of Digestive Endoscopy is a high-level medical academic journal specializing in digestive endoscopy, which was renamed Chinese Journal of Digestive Endoscopy in August 1996 from Endoscopy. Chinese Journal of Digestive Endoscopy mainly reports the leading scientific research results of esophagoscopy, gastroscopy, duodenoscopy, choledochoscopy, laparoscopy, colorectoscopy, small enteroscopy, sigmoidoscopy, etc. and the progress of their equipments and technologies at home and abroad, as well as the clinical diagnosis and treatment experience. The main columns are: treatises, abstracts of treatises, clinical reports, technical exchanges, special case reports and endoscopic complications. The target readers are digestive system diseases and digestive endoscopy workers who are engaged in medical treatment, teaching and scientific research. Chinese Journal of Digestive Endoscopy has been indexed by ISTIC, PKU, CSAD, WPRIM.