共聚焦激光显微内镜对胃非隆起型病变的诊断价值  

Diagnostic value of confocal laser endomicroscopy for non-protruding gastric lesions

作　　者：胡春玖[1] 薛寒冰[1] 戈之铮[1] 赵韫嘉[1] 陈晓宇[1] 陈海英[1] 戴军[1] 李晓波[1] 萧树东[1] 

机构地区：[1]上海交通大学医学院附属仁济医院消化内科,上海200001

出　　处：《中华消化内镜杂志》2011年第5期269-272,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨共聚焦激光显微内镜检查（CLE）对胃非隆起性病变良、恶性的鉴别诊断价值。方法对37例常规内镜发现的胃非隆起型病变患者行CLE检查。静脉注射荧光素钠后对病变区域进行观察，然后进行靶向活检。对CLE或靶向活检病理诊断为恶性病变者进行内镜或手术治疗，术后对整块标本进行病理学检查；对良性患者予规范药物治疗并每隔3个月复查胃镜，直至病变愈合。结果CLE诊断癌性病变11例，良性病变26例。靶向活检病理证实CLE诊断的11例癌变者中10例为癌，1例为良性；26例良性者中1例为癌，余皆为良性。共12例接受切除治疗（3例内镜治疗，9例外科手术），术后病理学证实与靶向活检病理诊断完全一致。良性者随访中未发现有恶变，经平均3．16（3．58±1．20）个月的内镜随访，病变均愈合。CLE对胃非隆起性病变癌变诊断的灵敏度、特异度和准确度分别为90．9％、96．2％和90．9％，阳性预测值和阴性预测值分别为90．9％和96．2％；CLE与组织学检查的Kappa值为0．871。结论CLE对胃非隆起型病变具有较高的诊断价值，将有望替代活检病理做出实时组织学诊断。Objective To discuss the differential diagnostic value of canfocal laser endomicroscopy （CLE） for benign and malignant non-protruding gastric lesions. Methods A total of 37 patients with nonprotruding gastric lesions diagnosed by conventional gastroscopy underwent CLE. Fluorescein sodium was intravenously injected, and target biopsy was obtained. Malignant lesionss diagnosed with CLE or biopsy were treated by endoscopy or surgery. Patients with benign lesions were give routine medication and followed up every 3 months until the lesions were cured. Results CLE diagnosed 11 malignant and 26 benign lesions. However, 1 of 11 cancers was confirmed as benign by histopathology, while 1 of 26 benign lesions was confirmed cancer. Lesions in 12 patients were resected, with 3 by endoscopy, and 9 by surgery, and findings of post-operative pathology were consistent with those of target biopsy. No malignancy was found during the follow-up of benign lesions, and all lesions were healed after 3.16 （3.58 ± 1.20） months. The sensitivity, specificity, and accuracy of CLE in diagnosis of malignant non-protruding gastric lesion were 90. 9%, 96. 2%, and 90. 9%, respectively. The positive and negative predictive values were 90. 9% and 96. 2%, respectively. The Kappa value of CLE and histopathology was 0. 871. Conclusion CLE is of significant value for the diagnosis of non-protruding gastric lesions, and may replace biopsy in real-time histological diagnosis.

关 键 词：共聚焦激光显微内镜 胃非隆起型病变 靶向活检 诊断 

分 类 号：R573[医药卫生—消化系统]