论文部分内容阅读
目的:研究共聚焦内镜(CLE)下胃黏膜萎缩的形态学特征,探讨其对伴有肠上皮化生诊断的可行性及准确性。方法:应用CLE对42例既往患有胃黏膜萎缩伴肠上皮化生的患者首先行胃镜检查,对黏膜可疑病变处行CLE扫描,分别给出内镜诊断和共聚焦活体组织学诊断。对扫描部位进行黏膜活检,分别对内镜诊断、共聚焦内镜诊断与病理组织学诊断进行对比分析。结果:CLE扫描42例患者获得7200帧图像,清晰显示胃小凹结构、柱状上皮细胞、杯状细胞、细胞周围结缔组织和微血管网图像。胃黏膜萎缩表现为单位视野内腺体数目减少、胃小凹间隙增宽;肠化腺体中的杯状细胞具有特殊的形态特征,易于识别。与病理结果对照研究显示:普通内镜诊断的敏感度、特异度及准确率分别为44%、16%和28%;共聚焦内镜敏感度、特异度及准确率分别为88%、87%和88%。结论:共聚焦显微内镜是一种全新的诊断工具,可以在内镜检查同时进行活体的虚拟组织学诊断,是诊断胃黏膜萎缩及胃黏膜肠上皮化生的一种有用的新方法。
Objective: To study the morphological characteristics of gastric mucosal atrophy under confocal endoscopy (CLE) and to investigate the feasibility and accuracy of the diagnosis of intestinal metaplasia. Methods: Forty-two patients with previous gastric mucosal atrophy and intestinal metaplasia were treated with gastroscopy. CLE was performed on suspected mucosal lesions, and endoscopic diagnosis and confocal live tissue histological diagnosis were performed. Mucosal biopsy of the scanning site, respectively, endoscopic diagnosis, confocal endoscopy diagnosis and histopathological diagnosis comparative analysis. RESULTS: In 42 patients with CLE scan, 7,200 images were obtained and the foveola structure, columnar epithelial cells, goblet cells, connective tissue around connective tissue and microvascular network were clearly displayed. Gastric mucosal atrophy showed a decrease in the number of glands per unit area and a widened gap in the fovea; the goblet cells in the gonadal glands had special morphological features that were easily identified. Compared with the pathological results, the sensitivity, specificity and accuracy of ordinary endoscopic diagnosis were 44%, 16% and 28% respectively; the sensitivity, specificity and accuracy of confocal endoscopy were 88%, 87% And 88%. Conclusion: Confocal microscopic endoscopy is a new diagnostic tool that can diagnose the gastric mucosal atrophy and gastric mucosal intestinal metaplasia as a useful new method for endoscopic diagnosis of virtual histology.