大连【201609论著】高分辨率显微内镜诊断胃癌的可行性研究
【201609论著】高分辨率显微内镜诊断胃癌的可行性研究
【摘要】
目的 探索高分辨率显微内镜（HRME）诊断胃癌的可行性。
方法 回顾性分析20例胃癌术后大体标本的胃癌组织和正常胃黏膜的HRME图片，总结图片特点，制定正常胃黏膜和胃癌组织的HRME诊断标准。在此基础上，对64例疑诊为胃癌的活检标本进行HRME前瞻性研究，将HRME预诊断结果与病理结果比较，评估HRME对胃癌的诊断价值。
结果 正常胃底黏膜HRME特点：黏膜浅层可见腺体排列规则，呈分枝状，胃小凹开口呈圆形或类椭圆形，周边裂隙呈线样，细胞核排列规则。正常胃窦黏膜HRME特点：浅层可见胃小凹开口呈不规则形或管状，腺腔呈裂隙状，小凹周围细胞排列规则，细胞核小且分布密集。胃癌组织HRME特点：细胞核大小不一，排列杂乱，腺体大小差异很大，结构显示不清或无法辨别腺体结构，胃小凹结构破坏，正常胃小凹结构消失。64例胃癌活检标本HRME成像对胃癌诊断的敏感度、特异度、准确度、阴性预测值和阳性预测值分别为96.4％（53／55）、88.9％（8／9）、95.3％（61／64）、98.1％（53／54）和80.0％（8／10）。
结论 HRME是一种新的价格低廉、操作简单的即时组织病理学成像工具。HRME可以很好地区分正常胃黏膜和胃癌组织，其对胃癌具有较高的诊断价值。
【关键词】高分辨率显微内镜；胃癌；诊断
基金项目：首都临床特色应用研究（Z141107002514099）
Feasibility of high resolution micro-endoscopy for diagnosis of gastric cancer
Tan Tao， Qu Yawei， Liu Minli， Liu Haifeng.
Department of Gastroenterology， General Hospital of Chinese People′s Armed Police Forces， Beijing 100039， China
Corresponding author: Liu Haifeng， Email：haifengliu333@163.com
【Abstract】
Objective To explore the feasibility of high-resolution micro-endoscopy for diagnosis of gastric cancer.
Methods A retrospective analysis of HRME pictures of gross specimen of gastric carcinoma of 20 cases of gastric cancer and normal gastric mucosa was made. Picture characteristics were studied and the HRME diagnostic criteria for normal gastric mucosa and gastric cancer tissues were developed. Based on the diagnostic criteria， a prospective study on gastric biopsy specimens of 64 cases of suspected gastric carcinoma was conducted and the diagnostic value of HRME for gastric carcinoma was evaluated by comparing HRME pre-diagnostic results with pathological findings.
Results In the superficial layer of the fundic mucosa， numerous regularly branched arranged glands as well as oval or elongated openings of the gastric pits and linear peripheral cracks were visible； the nuclei were arranged regularly. In the superficial layer of the antral mucosa， irregular or tubular openings of the gastric pits and cracked glandular cavities were visible， with the cells surrounding the gastric pits regularly arranged and the nuclei small and densely distributed. In the gastric carcinoma， nuclei sizes were different， arranged messy. Gland sizes were various， with unclear structure or glandular structures that could not be observed. Structure of gastric pits was damaged and normal gastric pits disappeared. After HRME imaging was performed on 64 cases of gastric biopsy specimens， the sensitivity， specificity， accuracy， negative predictive value and positive predictive value of HRME diagnosis of gastric carcinoma were 96.4％（53／55）， 88.9％（8／9）， 95.3％（61／64）， 98.1％（53／54） and 80.0％（8／10） respectively.
Conclusion HRME， a new and instant pathological imaging tool with low price and simple operation， can distinguish normal gastric mucosa and gastric cancer tissue clearly， with a high diagnosis value for gastric cancer.
【Key words】High-resolution micro-endoscopy；Stomach neoplasms；Diagnosis
Fund program：Capital Clinical Characteristic Application Research（Z141107002514099）
我是医生 说给你听
肖祥斌 胃肠科主任医师
→ 咨询给胃炎患者的几点意见：胃炎一般分为内痔、外痔和混合痔三种，而内痔又有一、二、三、四度之分，选择治疗方法必须根据患痔类型、轻重程度具体决定。如对症状较轻的一度、二度内痔可以选择药物治疗，而对早期血栓性外痔来说，手术治疗效果要比用药好。
程芳 女性胃肠主任
→ 咨询给胃炎患者的几点意见：注意饮食，忌酒和辛辣刺激食物，增加纤维性食物，多摄入果蔬、多饮水，改变不良的排便习惯，保持大便通畅，必要时服用缓泻剂，便后清洗肛门。对于脱垂型痔，注意用手轻轻托回痔块，阻止再脱出。避免久坐久立，进行适当运动。
相关文章阅读
- 大连【201609论著】高分辨率显微内镜诊断胃癌的可行性研究
- 大连【期刊扫描】结肠镜下黏膜切除术治疗老年较大息肉的结局
- 大连【201609论著】胃食管结合部早期癌53例内镜特征分析
- 大连GERD论坛 | 优秀病例赏析之《难治性胃食管反流病》
可在下面输入您的电话号码，点击免费通话,我们会第一时间拨打电话给您，全程通话免费。
