共聚焦激光显微内镜在内镜黏膜下剥离术后残留和复发病变诊断中的应用价值  

Value of Confocal Laser Endomicroscopy for Diagnosis of Residual and Recurrent Lesions after Endoscopic Submucosal Dissection

作　　者：范晓飞[1] 戈之铮[1] 薛寒冰[1] 赵韫嘉[1] 高云杰[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、上海市消化疾病研究所,200001

出　　处：《胃肠病学》2012年第8期462-465,共4页Chinese Journal of Gastroenterology

摘　　要：背景:内镜黏膜下剥离术(ESD)目前已广泛应用于胃癌前病变和早期胃癌的根治。普通白光内镜检查难以发现ESD术后的残留和复发病变,而共聚焦激光显微内镜(CLE)可对黏膜病变作出实时体内组织学诊断而无需活检。目的:探讨CLE在ESD术后残留和复发病变诊断中的应用价值。方法:连续纳入2009年6月～2011年12月上海仁济医院因胃上皮内瘤变或早期胃癌而接受ESD治疗的患者,分别于术后1、3、6个月行CLE随访。综合首次ESD、CLE复查发现病变后追加的手术切除以及CLE活检病理结果作出最终诊断,并与CLE诊断进行对照。结果:共20例行ESD治疗者纳入研究,所有患者均完成CLE随访。ESD术后1个月CLE复查发现2例残留病变,术后6个月CLE复查发现1例复发病变,CLE诊断均为高级别上皮内瘤变(HGIN)。追加剖腹手术病理诊断2例残留病变为HGIN,1例复发病变为早期分化型腺癌。其余17例患者3次CLE复查均未见病变残留或复发。结论:CLE检查可准确诊断ESD术后残留和复发病变,对ESD术后内镜随访具有重要价值。Background： Recently, endoscopic submucosal dissection （ESD） has been widely used in curative treatment of precancerous lesions and early gastric cancer （EGC）. The residual and recurrent neoplastic tissue after ESD are difficult to detect by conventional white light endoscopy, however, confocal laser endomicroscopy （CLE） can provide real time in vivo histological evaluation of mucosal lesions without the need for biopsy. Aims： To investigate the value of CLE for diagnosis of residual and recurrent lesions after ESD. Methods： Consecutive patients undergone ESD for gastric intraepithelial neoplasia or EGC between Jun. 2009 and Dec. 2011 at Shanghai Renji Hospital were enrolled. CLE was performed 1, 3 and 6 months after ESD. The results of CLE were analyzed in correlation with the final histological diagnosis based on ESD, additional resections after CLE, and biopsies of CLE. Results： Twenty patients undergone ESD were enrolled and completed the CLE follow up. CLE diagnosed residual lesion as high-grade intraepithelial neoplasia （HGIN） in 2 cases 1 month after ESD, and recurrent lesion as HGIN in 1 case 6 months after ESD. Pathological evaluation of the additional surgical excision specimen showed HGIN for 2 residual lesions and early differentiated adenocarcinoma for 1 recurrent lesion. No residual or recurrent lesions were found by 3 sessions of CLE in other 17 patients. Conclusions： CLE can diagnose residual and recurrent lesion and is valuable as an endoscopic surveillance after ESD.

关 键 词：共聚焦激光显微内镜 内镜黏膜下剥离术 胃肿瘤 肿瘤 残余 肿瘤复发 局部 

分 类 号：R735.2[医药卫生—肿瘤]