摘要目的 探讨频闪喉镜及窄带成像(narrow band imaging,NBI)内镜在声带白斑诊断中的应用价值.方法 回顾性分析2014年8月至2016年7月全麻支撑喉镜下喉显微手术明确病理性质的246例声带白斑患者的病历资料,比较术前频闪喉镜和NBI内镜在声带白斑病变诊断中的准确性.采用SPSS 21.0统计软件包进行数据处理.结果 频闪喉镜下黏膜波减低程度与病理分型的恶性程度呈显著正相关(Spearman相关系数r=0.526,P<0.01).NBI内镜下黏膜表面微细血管形态改变程度与病理分型的恶性程度呈显著正相关(Spearman相关系数r=0.480,P<0.01).对声带白斑中病理类型为浸润癌、原位癌及重度异型增生的病变,频闪喉镜的灵敏度较高,为92.73%,NBI内镜特异度较高,为90.55%.Logistic回归分析显示频闪喉镜下黏膜波中重度减低组及消失组出现恶性病变的概率是黏膜波正常或轻度减低组的3.906及19.737倍.黏膜波中重度减低组及消失组,NBI内镜结果对于预测病变性质差异有统计学意义(P<0.001,P=0.047).结论 声带白斑诊断中,频闪喉镜灵敏度高,单独使用频闪喉镜或频闪喉镜与NBI内镜联合应用均有助于预测声带白斑病变性质.对于频闪喉镜下黏膜波中重度减低和消失的患者,联合应用NBI内镜可提高诊断准确性.

abstractsObjective To investigate the value of stroboscopy and narrow band imaging ( NBI ) endoscopy in the diagnosis of vocal cord leukoplakia .Methods Two hundred and forty-six patients with vocal cord leukoplakia who underwent laryngeal microsurgery and diagnosed by histopathology were recruited between August 2014 and July 2016 in this retrospective study .The diagnostic accuracy of stroboscopy and narrow band imaging endoscopy in the diagnosis of vocal cord leukoplakia was compared .SPSS21.0 software was used to analyze the data .Results A significantly positive correlation was found between the decrease grade of mucosal wave and the histopathological diagnosis (Spearman r=0.526, P<0.01).A significantly positive correlation was found between the lesion classified by detailed morphologic findings of epithelial microvessel and the histopathological diagnosis ( Spearman r =0.480, P <0.01 ) .The sensitivity of stroboscopy for detecting severe dysplasia ,carcinoma and invasive carcinoma was 92.73%, higher than NBI endoscopy.The specificity of NBI endoscopy was 90.55%, higher than stroboscopy.The results of logistic regression analysis showed: the positive pathological type risk in the group with mucosal waves severely reduced and absent was 3.906 and 19.737 times higher than the group with mucosal waves slightly reduced . In the group with mucosal waves severely reduced and absent , significant difference was observed when combined use of NBI endoscopy ( P <0.001, P =0.047 ) .Conclusions In the diagnosis of vocal cord leukoplakia , stroboscopy is useful for detecting severe dysplasia , carcinoma and invasive carcinoma with high sensitivity.In the group with mucosal waves severely reduced and absent , combined use of NBI endoscopy was able to improve the diagnostic accuracy .