高分辨率显微内镜对胃溃疡良恶性鉴别的诊断价值*

Diagnostic value of high-resolution microendoscopy for identification of benign and malignant gastric ulcer*

摘要:

摘要：目的??探讨高分辨率显微内镜（HRME）对胃溃疡良恶性鉴别的诊断价值。方法?选取经病理确诊为良性胃溃疡患者的活检标本20例和恶性胃溃疡患者活检标本20例，并依据图片特点制定诊断标准。在此基础上，对56例既往经胃镜检查后确诊为胃溃疡的患者的活检标本进行前瞻性研究，将HRME成像预期结果与病理做对比。评价HRME对良性与恶性胃溃疡鉴别的诊断价值。结果?良性溃疡HRME图像特点：胃小凹基本特征尚未发生改变，排列规则，圆形小凹部分变成椭圆形，裂隙小凹可见延长扭曲，细胞核未见明显异形变化，可见结构与形态不成熟的新生小腺体。恶性胃溃疡HRME图像特点：腺体结构极紊乱，或腺体结构完全消失，胃小凹形态呈不规则变化或消失，细胞核增大，出现显现核团聚，排列紊乱无规则。56例113处活检病变经病理证实，良性溃疡62处，恶性及溃疡51处，白光内镜正确鉴别诊断72处病灶，HRME正确诊断102处病灶，HRME鉴别诊断效果明显优于白光内镜，其准确性、敏感性和特异性分别为88.50%、90.32%和86.28%。结论?HRME可以高效实时的进行细胞水平成像，在微结构上有效观察到病灶特征性变化，可以很好地鉴别诊断良恶性溃疡，提高胃黏膜溃疡诊断的准确性。

Abstract:

Abstract: Objective?To investigate the value of high-resolution microendoscopy (HRME) in the differential diagnosis of benign and malignant gastric ulcer.?Methods?20 patients with biopsy specimens diagnosed as pathological gastric ulcer and 20 patients with malignant gastric ulcer biopsy specimens were selected and the diagnostic criteria were established according to the characteristics of the pictures. On this basis, a prospective study was performed on 56 biopsy specimens of patients with gastric ulcer after previous gastroscopy, and the expected results of HRME imaging were compared with pathology. To evaluate the diagnostic value of HRME for benign and malignant ulcers.?Results?The characteristics of HRME images of benign ulcers: the basic characteristics of gastric pits have not changed, the rules are regular, the circular concaves become elliptical, the cracks are visible and prolonged, and the nucleus has no obvious abnormal changes. The structure and morphology are immature newborn small glands. The characteristics of HRME in malignant gastric ulcer are: the gland structure is extremely disordered, or the gland structure completely disappears, the shape of the gastric pit is irregularly changed or disappeared, the nuclei are enlarged, the appearance of nuclear agglomeration, and disordered arrangement are irregular. 56 cases of 113 biopsy lesions were confirmed by pathology, 62 benign ulcers, 51 malignant and ulcers, white light endoscopy correctly identified 72 lesions, HRME correctly diagnosed 102 lesions, HRME differential diagnosis was significantly better than white endoscopy. The accuracy, sensitivity and specificity were 88.50%, 90.32% and 86.28%, respectively.?Conclusion?High-resolution microendoscopy can perform high-efficiency real-time cell-level imaging, and effectively observe the characteristic changes of the lesions on the microstructure. It can be a good differential diagnosis of benign and malignant ulcers and improve the accuracy of diagnosis of gastric mucosal ulcers.