| 董楠楠.窄带成像喉镜及频闪喉镜在喉癌治疗后随访过程中的价值研究[J].浙江中西医结合杂志,2026,36(7): |
| 窄带成像喉镜及频闪喉镜在喉癌治疗后随访过程中的价值研究 |
| The value of narrowband imaging laryngoscope and stroboscopic laryngoscope in the follow-up process of laryngeal cancer treatment |
| 投稿时间：2025-03-18 修订日期：2026-06-02 |
| DOI： |
| 中文关键词: 窄带成像喉镜 频闪喉镜 喉癌 随访 价值 |
| 英文关键词:Narrowband imaging laryngoscope Stroboscopic laryngoscope Laryngeal cancer Follow up Value |
| 基金项目:嘉兴市科学技术关于下达2022年嘉兴市公益性研究计划项目（编号：2022AD30012） |
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| 中文摘要: |
| 目的：分析窄带成像喉镜(NBI)及频闪喉镜在喉癌治疗后随访过程中的价值。方法：选择本院就诊的喉癌治疗后不同时期的患者,分为4组,1组为全喉切除术患者,2组为单纯部分喉切除术后患者,3组为部分喉切除联合放化疗后患者,4组为单纯放疗后患者。以病理结果为金标准,分析普通白光内镜(WLE)、NBI、频闪喉镜在喉癌治疗后随访过程中的价值,以及频闪喉镜黏膜波变化特点、NBI下病变性质判断结果。结果：单独NBI诊断的灵敏度96.43%、特异度66.67%、阳性预测值93.10%、阴性预测值80.00%、准确度91.18%、AUC 0.815、Youden指数0.631均高于单独WLE的78.57%、33.33%、84.62%、25.00%、70.59%、0.560、0.119。经Z检验比较AUC,单独NBI的AUC较单独WLE的AUC差异有统计学意义(Z=2.000,P=0.045)。联合诊断的灵敏度98.08%、特异度90.00%、阳性预测值96.23%、阴性预测值94.74%、准确度95.83%、AUC 0.940、Youden指数0.881高于单独频闪喉镜(84.62%、65.00%、86.27%、61.90%、79.11%、0.748、0.496)、高于单独NBI(71.15%、55.00%、80.43%、42.31%、66.67%、0.631、0.262)、高于单独WLE(65.38%、45.00%、75.56%、33.33%、59.72%、0.552、0.104)。经Z检验比较AUC,联合的AUC较单独频闪喉镜、较单独NBI、较单独WLE的AUC差异有统计学意义(Z=2.367、3.615、4.448,P=0.018、0.000、0.000)。频闪喉镜下黏膜波“正常或轻度减低”13例(18.06%),频闪喉镜下黏膜波“中或重度减低”15例(20.83%),频闪喉镜下黏膜波“消失”44例(61.11%)。正常或轻度减低组主要为“炎性组织”(92.31%),消失组主要为“鳞状细胞癌”(68.18%)、“重度不典型增生病变”(29.55%)。NBI下病变性质“良性病变”11例(15.28%),“可疑恶性病变”24例(33.33%),“恶性病变”37例(51.39%)。良性病变组主要为“炎性组织”(72.73%)、“轻度不典型增生病变”(27.27%),恶性病变组主要为“鳞状细胞癌”(56.76%)、“重度不典型增生病变”(40.54%)。结论：NBI及频闪喉镜对喉癌治疗后复发有重要价值,可作为喉癌治疗后随访过程中的检查方法。 |
| 英文摘要: |
| Objective: To analyze the value of narrowband imaging laryngoscope (NBI) and stroboscopic laryngoscope in the follow-up process after laryngeal cancer treatment. Methods: Patients with laryngeal cancer treated in our hospital at different stages were gathered and assigned into four groups: Group 1 underwent total laryngectomy, group 2 underwent simple partial laryngectomy, group 3 underwent partial laryngectomy combined with radiotherapy and chemotherapy, and group 4 underwent simple radiotherapy. Using pathological results as the gold standard, the values of ordinary white light endoscopy (WLE), NBI, and stroboscopic laryngoscope in the follow-up process of laryngeal cancer treatment, and the changes characteristics of mucosal waves under stroboscopic laryngoscope, and the results of lesion nature judgment under NBI were analyzed. Results: The sensitivity, specificity, positive predictive value, negative predictive value, accuracy, AUC, and Youden index of NBI diagnosis alone were 96.43%, 66.67%, 93.10%, 80.00%, 91.18%, 0.815, and 0.631, respectively, which were higher than those of WLE alone (78.57%, 33.33%, 84.62%, 25.00%, 70.59%, 0.560, and 0.119). According to the Z-test, there was a statistically obvious difference in AUC between NBI alone and WLE alone (Z=2.000, P=0.045). The sensitivity, specificity, positive predictive value, negative predictive value, accuracy, AUC, and Youden index of the combined diagnosis were 98.08%, 90.00%, 96.23%, 94.74%, 95.83%, 0.940, and 0.881, respectively, which were higher than those of the stroboscopic laryngoscope alone (84.62%, 65.00%, 86.27%, 61.90%, 79.11%, 0.748, 0.496), higher than those of the NBI alone (71.15%, 55.00%, 80.43%, 42.31%, 66.67%, 0.631, 0.262), and higher than those of the WLE alone (65.38%, 45.00%, 75.56%, 33.33%, 59.72%, 0.552, 0.104). After comparing the AUC using Z-test, there was a statistically obvious difference in the AUC of the combined diagnosis to the single use of laryngoscope, NBI, and WLE (Z=2.367, 3.615, 4.448, respectively, P=0.018, 0.000, 0.000). The 13 cases (18.06%) showed "normal or mild reduction" of mucosal waves under stroboscopic laryngoscope, 15 cases (20.83%) showed "moderate or severe reduction" of mucosal waves under stroboscopic laryngoscope, and 44 cases (61.11%) showed "disappearance" of mucosal waves under stroboscopic laryngoscope. The normal or mild reduction group mainly consisted of "inflammatory tissue" (92.31%), while the disappearance group mainly consisted of "squamous cell carcinoma" (68.18%) and "severe atypical hyperplasia lesions" (29.55%). Under NBI, there were 11 cases (15.28%) of benign lesions, 24 cases (33.33%) of suspected malignant lesions, and 37 cases (51.39%) of malignant lesions. The benign lesion group mainly consisted of "inflammatory tissue" (72.73%) and "mild atypical hyperplasia lesions" (27.27%), while the malignant lesion group mainly consisted of "squamous cell carcinoma" (56.76%) and "severe atypical hyperplasia lesions" (40.54%). Conclusion: NBI and stroboscopic laryngoscope have important value in detecting recurrence of laryngeal cancer after treatment, and they can be used as examination methods in the follow-up process of laryngeal cancer treatment. |
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