高清智能电子染色内镜联合频闪喉镜在声带白斑患者中的应用效果

Application effect of high-definition intelligent electronic staining endoscopy combined with stroboscope in patients with vocal cord leukoplakia

摘要:

目的 分析高清智能电子染色内镜（i-Scan）联合频闪喉镜在声带白斑患者中的应用效果。方法 对2021年1月－2022年12月该院的80例声带白斑患者进行回顾性研究，所有患者均经CO₂激光喉内显微镜手术以明确病理性质，术前均给予i-Scan和频闪喉镜检查。分析i-Scan和频闪喉镜对声带病变的病理诊断情况，比较i-Scan和频闪喉镜的病灶血管形态评分和病变边界评分，观察声带白斑患者i-Scan下微血管形态特点和病理类型分布，以及频闪喉镜下黏膜波特点和病理类型分布，并采用受试者工作特征曲线（ROC curve）分析i-Scan和频闪喉镜对微血管形态和黏膜波改变的预测价值。结果 以术后病理为最终诊断，5例因表面覆盖白斑或坏死物导致i-Scan和频闪喉镜检查失败，i-Scan检查的诊断符合率为68.00%（51/75），频闪喉镜的诊断符合率为89.33%（67/75）。i-Scan检查的病灶血管形态评分和病变边界评分高于频闪喉镜检查，差异均有统计学意义（P < 0.05）。67例水平血管改变，以鳞状上皮单纯增生、慢性炎症和轻度异型增生为主，8例垂直血管改变，以轻度异型增生为主，i-Scan下微血管形态方向变化与病理结果良恶性比较，差异有统计学意义（P < 0.05），且呈正相关。62例黏膜波正常或轻度减退，以鳞状上皮单纯增生、慢性炎症和轻度异型增生为主，13例黏膜波重度减退或消失，以鳞状上皮单纯增生为主，频闪喉镜下黏膜波减退程度与病理结果良恶性比较，差异有统计学意义（P < 0.05），且呈正相关。单独采用i-Scan或频闪喉镜检查，对于声带白斑患者的良恶性预测效果无明显差异（P > 0.05），而i-Scan联合频闪喉镜检查的预测效果优于单独使用（P < 0.05）。结论 i-Scan联合频闪喉镜检查对于声带白斑患者的声带黏膜下微血管、黏膜波和形态有较佳的评估价值，联合使用对于良恶性病变的预测价值优于单独使用。

Abstract:

Objective To analyze the application effect of high-definition intelligent electronic staining endoscopy (i-Scan) combined with stroboscope in patients with vocal cord leukoplakia.Methods A retrospective study was carried out on 80 patients with vocal cord leukoplakia from January 2021 to December 2022. All the patients were confirmed by CO₂ laser laryngoscopy to determine their pathological properties, and all the patients were given i-Scan and stroboscope before operation. Analyze the pathological diagnosis of vocal cord lesions by i-Scan and stroboscope, compare the lesion vascular morphology score and lesion boundary score of i-Scan and stroboscope, observe the microvascular morphological characteristics and pathological type distribution under i-Scan in patients with vocal cord leukoplakia, as well as the mucosal wave characteristics and pathological type distribution under stroboscope in patients with vocal cord leukoplakia, and analyze the predictive value of i-Scan and stroboscope on microvascular morphology and mucosal wave changes by receiver operator characteristic curve (ROC curve).Results Taking the postoperative pathology as the final diagnosis, 5 patients with vocal cord leukoplakia failed to be examined by i-Scan and stroboscope because of the white spot or necrotic substance on the surface. The diagnostic accuracy rate of i-Scan was 68.00% (51/75), and the diagnostic accuracy rate of stroboscope was 89.33% (67/75). The lesion vascular morphology score and lesion boundary score of i-Scan were higher than those of stroboscope (P < 0.05). 67 cases had horizontal vascular changes, mainly with simple hyperplasia of squamous epithelium, chronic inflammation and mild dysplasia, and 8 cases had vertical vascular changes, mainly with mild dysplasia. The change of microvessel morphology and direction under i-Scan was significantly different from the pathological results (P < 0.05), and was positively correlated. 62 cases had normal and mild mucosal wave attenuation, mainly with simple hyperplasia of squamous epithelium, chronic inflammation and mild dysplasia, 13 cases had severe attenuation and disappearance, mainly with simple hyperplasia of squamous epithelium. The degree of mucosal wave attenuation under stroboscope was statistically significant (P < 0.05), and was positively correlated with the benign and malignant results. There was no statistically significant difference in the predictive effect of i-Scan or stroboscope alone on the benign and malignant of patients with vocal cord leukoplakia (P > 0.05), while the predictive effect of i-Scan combined with stroboscope was better than that of alone (P < 0.05).Conclusion i-Scan combined with stroboscope has a better value in evaluating the submucosal microvessels, mucosal waves and morphology of vocal cords in patients with vocal cord leukoplakia, and the combined application has a better predictive value for benign and malignant lesions than the single application.