目的 分析应用蓝激光成像技术(BLI)联合内镜智能分光比色技术(FICE)诊断早期食管癌的临床意义。方法 收集本院及下级医院2016年1月—2018年6月在普通内镜下发现的108例食管可疑病变患者,分别给予白光、FICE和BLI不同模式进行观察诊断,再结合放大模式对病变部位的上皮乳头内毛细血管袢(IPCL)进行观察、分型、判断性质。最后取活检送病理学检查。内镜数据和病理数据采用Kappa一致性检验方法、Spearman相关性分析,统计每种内镜检查模式诊断的准确性,分析各方法下IPCL分型与病理诊断之间的相关性。结果 Kappa一致性检验显示,白光内镜、FICE、BLI以及FICE+BLI等模式诊断早期食管癌的准确度、敏感度、特异度、阳性预测、阴性预测及Kappa值呈逐步升高;Spearman相关性分析显示,FICE、BLI以及BLI与FICE联合诊断时,IPCL分型与早期食管癌的诊断均呈正相关,且BLI联合FICE的相关性强于BLI或FICE单独诊断。结论 BLI联合FICE可显著提高早期食管癌的诊断率,结合放大内镜下IPCL分型可判断早期食管癌病理分型。

Objective To analyze the clinical significance of blue laser imaging (BLI)technology combined with Fuji intelligent chromo endoscopy (FICE)in the diagnosis of early esophageal cancer. Methods 108 cases of patients with esophageal suspicious lesions admitted to our hospital from January 2016 to June 2018 were enrolled in the study. They were given different modes of white light, FICE and BLI for observation and diagnosis, and the magnifying endoscopy model was combined to observe the intraepithelial papillary capillary loop (IPCL)at lesions sites for IPCL typing. After complete endoscopic examinations, the lesions were taken for pathological examination. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value and Kappa value of each method were tested by Kappa consistency test. Spearman correlation analysis was used to analyze the correlation between IPCL classification and pathological diagnosis under each method. Results Kappa consistency test showed that the accuracy, sensitivity, specificity, positive predictive value, negative predictive value and Kappa value of white light endoscopy, FICE, BLI and FICE+BLI were increased in the diagnosis of early esophageal cancer. IPCL classification under combined magnifying endoscopy showed that type IV was mainly early esophageal cancer, and types I-III were mainly precancerous lesions. Spearman correlation analysis showed that through FICE, BLI and BLI combined with FICE for diagnosis, IPCL classification was positively correlated with early esophageal cancer, and the correlation of BLI combined with FICE was stronger than that of BLI or FICE. Conclusions BLI combined with FICE can greatly improve the diagnosis rate of early esophageal cancer. Combined with magnifying endoscopy, IPCL classification can judge the pathological types of early esophageal cancer.