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目的 探讨窄带成像技术(NBI)联合放大内镜在胃癌早期诊断中的价值,观察其是否有助于经验欠缺内镜医生诊断.方法 选择2015年4月至2017年10月在本院就诊的经普通白光内镜(WLE)检查发现存在病变的480处病灶,以病理检测作为诊断的金标准,选取3名内镜阅片经验丰富的医生进行阅片.选取40名实习内镜医生,简单培训后,随机选取80处WLE图片和窄带成像技术联合放大内镜(ME-NBI)图片举办阅片会,采用实时投票判断病变性质.结果 ME-NBI诊断的准确率、灵敏度、特异度、假阳性率、假阴性率分别为97.9％ (470/480),96.8％ (120/124),98.3％(350/356),1.7％(6/356),3.2％ (4/124);WLE诊断的准确率、灵敏度、特异度、假阳性率、假阴性率分别为91.7％(440/480),80.6％(100/124),89.9％(320/356),10.1％(36/356),19.4％(24/124),ME-NBI诊断准确率、灵敏度和特异度明显高于WLE(x2=18.989,16.104,15.859,P≤0.05),其假阳性率、假阴性率明显低于WLE(x2=22.772,16.104,P≤0.05).40名内镜实习医生的ME-NBI阅片诊断结果明显优于WLE(t=11.467,16.188,P≤0.05).结论 ME-NBI筛查早期胃癌,准确度度令人满意,且对于经验不足的医生也具有一定的诊断价值.

Objective To explore the effect of nanow-band imaging (NBI) combined with magnifying endoscopy (ME) in early diagnosis of gastric cancer,and to observe whether it is helpful for inexperienced endoscopists to diagnose.Methods From April 2015 to October 2017,a total of 480 lesions were selected as research objects which were detected in the normal white light endoscopy (WLE).Pathological examination was used as the gold standard for diagnosis.3 experienced doctors were selected to read the endoscopy films.40 intern endoscopy doctors were selected to read the endoscopy filins at the same time after simple training.80 WLE images and narrowband imaging technology combined with magnifying endoscopy (ME-NBI) images were randomly selected to hold a film reading meeting.Real-time voting was used to judge the nature of lesions.Results The accuracy,sensitivity,specificity false positive rate and false negative rate of ME-NBI were 97.9％ (470/480),96.8％ (120/124),98.3％ (350/356),1.7％ (6/356),3.2％(4/124).And WLE values were 91.7％ (440/480),80.6％ (100/124),89.9％ (320/356),10.1％ (36/356),19.4％ (24/124),respectively.The diagnostic accuracy,sensitivity and specificity of ME-NBI were significantly higher than those of WLE (x2 =18.989,16.104,15.859,P≤0.05),and the false positive rate and false negative rate were significantly lower than those of WLE (x2 =22.772,16.104,P ≤ 0.05).The diagnostic results of ME-NBI of 40 endoscopy interns were significantly better than those of WLE (t =11.467,16.188,P ≤0.05).The diagnostic results of NBI by 40 interns were significantly better than that of WLE (t =11.467,16.188,P ≤ 0.05).Conclusions The accuracy of ME-NBI in screening early gastric cancer is satisfactory,and it has certain diagnostic value for inexperienced doctors.