内镜窄带成像技术结合放大内镜在鉴别结直肠病变中的作用及其学习曲线

摘要： 目的 探讨内镜窄带成像技术（NBI）在诊断结直肠病变中的作用。明确NBI 在实际操作中的 学习曲线，为开展该技术的临床医师提供指导。方法 回顾性分析2015 年6 月-2016 年6 月该院内镜中心4 位医师行NBI 结合放大内镜检查并发现结直肠病变的289 例患者临床资料，所有病变经活检、内镜下治疗或 手术后行病理组织学检查，并与佐野分型对照。根据NBI 结合放大内镜分为3 组，这3 组包括可以通过内镜 治疗（目标病变）的病变和不能通过内镜治疗（非目标病变）的病变。每位医师检查的目标或非目标病变均 达到15 例为1 组。通过评估4 名医师对每组病变的诊断准确性，绘制NBI 结合放大内镜检查技术的相关学 习曲线。结果 在289 例患者的结肠镜检查中共发现372 处病变，NBI 结合放大内镜使用佐野分型在鉴别肿 瘤和非肿瘤性病变的准确率为95.1%、敏感性为98.0%、特异性为92.0%。对于目标及非目标病变的诊断准确 率第2 组相比第1 组均有明显提高[ 分别为81.7% vs 95.1%（P =0.010）和71.7% vs 93.4%（P =0.000）] ；第2 组与第3 组病变之间的诊断准确率的差异无统计学意义（P =0.984 及P =0.117）。结论 NBI 结合放大内镜 是诊断结直肠病变的有效工具。对于无NBI 经验的医师在完成较短的训练计划和一定（对目标及非目标病变 各15 例）的临床实践后基本掌握其诊断方法，并获得有效、稳定的诊断准确率。
Abstract: Objective To evaluate the usefulness of narrow-band imaging with magnification in differentiating colorectal lesions, and assess for a learning curve, to gave help for the clinician, who want to carry out the technique. Method We retrospectively analyzed the clinical data of 289 patients who underwent NBI combined with magnification by four endoscopic physician, from June, 2015 to June, 2016, all the lesions were biopsied, endoscopic treatment or postoperative pathology and pathological examination, and the Sano classification control. All lesions were divided into three groups according to the NBI combined with magnifying endoscopy, these three sets included both lesions requiring endoscopic treatment (e.g. target lesions) and lesions that were not, or could not be, treated by endoscopy (e.g. nontarget lesions). Each physician examined the target or non-target lesion reached 15 cases as a group. By assessing the diagnostic accuracy of the four physicians for each group of lesions, an associated learning curve of NBI combined with magnifying endoscopy was developed. Result In 289 patients, 372 lesions were found by colonoscopy. NBI combined with magnifying endoscopy was 95.1%, 98.0% and 92.0%, respectively, in the identification of tumor and non-neoplastic lesions. The accuracy of the diagnosis of target and non-target lesions was significantly higher in group 2 than in group 1 [81.7% vs 95.1% (P = 0.010) and 71.7% vs 93.4%(P = 0.000)]. There was no significant difference in the diagnostic accuracy between group 2 and group 3 (P = 0.984 and P = 0.117). Conclusion It is very useful to use narrow-band imaging and Sano CP analysis in the differential diagnosis of colorectal lesions. The endoscopists who had never used NBI or no knowledge of NBI can have effective and stable diagnostic accuracy after using NBI with magnification to diagnose 15 target and non-target lesions respectively.