| Research background:The morbidity and mortality of esophageal cancer rate in our country has been in the front rank of the world. In China, died of malignant tumors in patients with esophageal cancer each year, accounting for about 1/4 in all malignant tumors, in second place, second only to gastric cancer. The reason is clear diagnosis, patients often have appeared different degree of lymph node metastasis or distant metastasis, belongs to the advanced esophageal carcinoma, most of them have lost the chance of radical operation excision, partial even with the operation opportunity, operation is often the way to remove the tumor, resection of the lesion, but postoperative patients for 5 years survival rate is only 6%-15%. While the early esophageal cancer whether operation operation or endoscopic surgical treatment after complete resection, 5 years survival rate can be as high as 90%[1]. The key to decide the success rate of treatment in patients with esophageal cancer, increase the 5 year survival rate, improve prognosis, improve the quality of life is to achieve the "three early", namely the early discovery, early diagnosis, early treatment. At present, endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), polycyclic ligation under endoscopy mucosal resection (MBM) and other endoscopic treatment of early esophageal cancer technology matures, surgical operation can achieve the same effect. But the early discovery, early diagnosis is the basis of early treatment. Therefore in order to improve the esophageal cancer patients 5 years survival rate and improve the prognosis, improving the life quality of the patients, improve the detection rate of early esophageal cancer is the key. Because patients with early esophageal cancer started to step 3 to a relatively stable state, in 4 years during this period in the disease, the disease will not happen fast development, this also objectively for the early diagnosis of esophageal cancer has provided extremely favorable conditions [2]. In recent years, with the continuous progress of science and technology, the development of endoscopic imaging technology continues to mature and related technical field, early diagnosis, early treatment has become the research focuses on the gastrointestinal Department of internal medicine doctors [3].With the continuous development of endoscopic techniques, the new rise of magnifying endoscopy and narrow-band imaging (magnifyingendoscoy, narrow-band imaging, NBI) can be clearly observed in esophageal epithelial nipple within capillary (intra papillary capillary loops, IPCL), a preliminary judge the level of lesion, NBI rely on spectral range and IPCL form to show pathological changes, implement the endoscopic "dyeing" light, without adjuvant drugs, no obvious contraindicated in the process of checking and any discomfort, compared with iodine staining, it has the obvious superiority in some areas, represents the development trend of the endoscope and molecular biology endoscopy. NBI joint magnification endoscopy mode, the principle is to strengthen the IPCL and diseased tissue around the color difference, can accurate the mucosa of normal and pathological changes of mucosa, clearly see the IPCL form, at the same time improve the detection accuracy structure. By three bands such as red, green, and blue color contrast, compare common magnification endoscopy with NBI endoscopic IPCL magnified, clarity, and blood vessels and mucous membrane of color contrast ratio, and the mathematical calculation, the results also found that, under the enlarge NBI endoscopy, IPCL color contrast is more obvious with the surrounding mucosa, contrast ratio is the largest, can get a better look of IPCL change.Applications of NBI can help predict the organization of lesions on the pathology, can improve our organization in patients with early esophageal lesions in front of the objective detection rate. Narrow-band imaging endoscopy were pathological changes of target detection, have a great effect to improve the rate of early esophageal cancer, has a certain clinical significance. NBI also has a lot of insufficient places, for example, feed pipe cleaning is not strong enough, will have an impact on judgment of the results. And mucosa bleeding will influence the accuracy of the results. Another IPCL parting no exact regulation, and because of the type of parting is strongly influenced by subjective factors, no concrete decision criteria. But overall, the NBI is convenient in operation, at the same time, combined with the magnification endoscopy helps to improve rate of early esophageal cancer, malignant tissue, diseased tissue for the probability of targeted biopsy will further improve, this will help the depth of the lesion site and the method of treatment is widely used, suitable for clinical application.Objective:to study the endoscopic based on narrow-band imaging (Narrow-Band Imaning NBI) under the function and significance of early esophageal cancer diagnosis.Methods:100 cases of the subjects included in this study (including 10 healthy subjects), the subjects in 57 cases of the men and women in 43 cases, the subjects aged between 32-65, the average age was 53.5+/-4.7 years old. Experiment is divided into two groups, group A with normal iodine staining (22 cases (28 male, female). Group B using NBI with iodine staining (male 29 cases, female 21 cases). In the experiments, confirmed by histopathology certification, A group of patients with esophageal tissue pathological changes of 11 cases; Light-18 patients with severe atypical hyperplasia; Of 6 patients with esophageal cancer early,15 cases of severe atypical hyperplasia. There are 7 patients with esophageal tissue pathological changes of group B; Light-17 patients with severe atypical hyperplasia; Of 17 patients with esophageal cancer early,9 cases of severe atypical hyperplasia. Experiments in esophageal cancer patients after EMR/ESD or surgical treatment, in the study to complete after surgery to remove the sample tissue pathology for the main standard. 100 cases of individuals with common endoscopic observation projects, performance was abnormal, ordinary endoscopy and narrow-band imaging technology, were used respectively to staining endoscopy and combined with enlarged endoscopic technology respectively. As a result, the evaluation of each mode were examined the outline of the lesion site, superficial MAO vascular structures form the visibility of the image. Operators are observed under the use of narrow-band imaging endoscopy epithelial nipples in the capillary loops (intrapapillary capillary loop, IPCL) are classified, and the pathological changes of the most obvious places to live check pathological tissue, identified as early esophageal cancer, should undertake the corresponding surgery or endoscopic treatment. Will be observed under endoscopy narrow-band imaging results were compared with endoscopic ultrasonography. Includes standard is:(1) thickening of the mucosa of the esophagus, turbidity and vascular structure chaos; (2) the mucous membrane of esophagus partial red area and white area color change; (3) mucosa of the esophagus appears slightly higher than that of mucous membrane surface, the surface rough or erosion site focal plaques, focal, more can be gray, or tiny concurrent nodules or similar sand particles; (4) Colonic mucosa of the esophagus local hyperemia color erosion is abnormal, there is a slight change of patients such as uplift sag; (5) esophageal mucosal parts rough, irregular thickening, or the change of the particle, thus no normal mucosal morphology. Ruled out the standard as follows:(1) have allergic constitution, liquid of lugol iodine allergy, allergic to iodine, or patients with hyperthyroidism disease history; (2) the kidney dysfunction or suffering from the disease; (3) the digestive tract infarction or perforation patients; (4) endoscopic operation contraindication certificate. Experiments on 100 cases of patients with clinically common endoscopic examination and NBI imaging examination, and after lugol iodine staining and joint observation of magnifying endoscopy in detail.Results:(1) in the observed image visibility on the lesion site, patients with NBI and endoscopic observation after dyeing, no difference in statistics, but both on the treatment and diagnosis of early esophageal cancer patients have advantages than ordinary endoscopy. In the outline of the lesion site was observed, the forms of IPCL visibility, NBI combined with endoscopic magnification endoscopy than normal amplification and magnification endoscopy after dyeing better resolution (P= 0.0322).(2) of 50 cases of patients with early esophageal carcinoma is common endoscopic examination, including early canceration in 6 cases,11 cases of inflammation, mild to moderate dysplasia of 18 cases,15 cases of severe dysplasia and early detection rate of 12%. Is early esophageal carcinoma patients with 50 cases of NBI staining endoscopy check, including early canceration in 17 cases.6 cases of inflammation. Mild to moderate dysplasia in 17 cases,9 cases of severe dysplasia and early detection rate of 34%.(3) 66.7%(12/18) in the experiments of the IPCL classification for patients with esophagitis II type; 62.9% (22/35) of the light to moderate dysplasia group IPCL parting III type; 100% (24/24) of severe atypical biochemical IPCL classification for the type IV.These results are shown:to observe the pathological changes of patients with clarity, dyeing agent and NBI endoscopy results similar to contrast ordinary endoscopy has advantages. But the IPCL on observation clarity, dye NBI endoscopic imaging is a greater advantage, compared to ordinary endoscopy, using NBI model after dyeing, normal tissues can clear contrast with pathological changes. To the area of the lesion site and form the size of the difference and the knowledge is becoming more and more accurate, and can show the uplift of the local lesion morphology pitting different than the original. For the white light mode, esophageal cancer early check the omission phenomenon to fill a vacancy.Conclusion:the narrow-band imaging (NBI) is of early esophageal cancer diagnosis and check the detection method has important significance. In the gastrointestinal tract disease diagnosis and early treatment has showed significant results. It overcome the disadvantages of conventional endoscopic diagnosis technology, and in the digestive tract disease diagnosis and treatment of the operation method is simple, can be clear to the lesion area, and can more clearly observed in various forms of IPCL, the diagnosis of early esophageal carcinoma in the preliminary judging its traits and infiltration depth of the lesion has a certain significance. |
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