光学相干断层扫描在胃肠肿瘤外科中的应用进展  

Progress of the application of optical coherence tomography in gastrointestinal tumor surgery

作　　者：李永盛[1] 刘浩[1] 黄海鹏[1] 朱煜[1] 邓海军[1] 余江[1] 罗斯特[2] 霍力[2] 林立 谢会开[4] 李国新[1] 

机构地区：[1]南方医科大学南方医院普通外科,广州510515 [2]清华大学电子工程,北京100084 [3]无锡微奥科技有限公司,214135 [4]FL32611美国佛罗里达大学

出　　处：《中华胃肠外科杂志》2017年第6期716-720,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：国家临床重点专科建设项目（2012）

摘　　要：光学相干断层扫描（OCT）是一种实时三维层析光学成像技术。OCT的物理原理类似于超声检查，但其采用的是近红外光而不是声波，它可以提供拥有微米级分辨率的活体组织形态的断面图像。通过与内镜、细针、导管、腹腔镜等装置结合，OCT在肿瘤外科中拥有巨大的成像潜力。目前研究提示，OCT技术在以下胃肠道肿瘤外科领域具有应用潜力：（1）早期肿瘤筛查和诊断：OCT可区分息肉组织、正常组织、恶性组织之间的差异，可能鉴别癌前病变，例如胃肠化生，幽门螺杆菌相关胃炎，涉及黏膜或黏膜下层的早期胃癌，以及区分腺瘤性息肉和增生性息肉。（2）淋巴结的光学活检：作为一种高分辨率近红外成像模式，OCT能够可视化组织内的微观特征，区别淋巴结组织与周围脂肪组织，并显示淋巴结结构（例如生发中心和结节内血管），以展示转移性肿瘤浸润过程中淋巴结显微结构变化。（3）精确手术导航，术中指导切除范围：在口腔鳞状细胞癌和乳腺癌等其他肿瘤中发现，OCT可以通过快速大面积扫描，以在细胞水平上引导外科手术切除肿瘤性疾病，并扫描肿瘤边缘的残留肿瘤灶，甚至是转移肿瘤细胞，这提示在结直肠肿瘤外科中，未来术中应用腹腔镜OCT实时检测肠管切缘及淋巴结的可行性，从而可确定适宜的肠管切除范围及淋巴结清扫范围。目前，关于OCT在胃肠肿瘤外科的术中应用的相关报道甚少，提示OCT在这一领域有广大的研究空间。Optical coherence tomography （OCT） is a real-time, cross-sectional optical imaging technology. It is analogous to ultrasonography, except that OCT uses light waves instead of sound waves, and can provide three-dimensional morphological images of living tissues with a micrometer resolution. Through the use of endoscopes, needles, catheters and laparoscopes, OCT has demonstrated tremendous imaging potential in tumor surgery. The current studies suggest that OCT has potential for clinical applications in the following fields of gastrointestinal tumor surgery： （1） Early tumor detection and diagnosis： OCT can distinguish differences between polyp tissue, normal tissue and malignant tissue. It could possibly identify premalignant lesions or conditions potentially predisposing to malignancy, such as gastric and intestinal metaplasia, gastritis associated with Helicobacter pylori, and early gastric cancer involving the mucosa or submucosa. In addition, OCT can differentiate between adenomatous polyps and hyperplastic polyps. （2） Optical biopsy of lymph nodes： As a high-resolution, near-IR imaging modality, OCT is capable of visualizing microscopic features within tissue, distinguishing lymph node tissue from surrounding adipose tissue, revealing nodal structures such as germinal centers and intra-nodal vessels. Consequently, OCT has the ability to show changes in node microarchitecture during metastatic tumor infiltration. （3） Intraoperative guidance for real-time determination of surgical margins： In other tumors such as oral squamous cell carcinoma and breast cancer, it has been demonstrated that OCT can be used to rapidly scan large areas of tissue, to guide at the cellular level the surgical resection of neoplastic disease, and to scan tumor margins for the presence of residual disease, tumor foci, and potentially even metastasizing tumor cells. It implies that colorectal neoplasms surgeons can possibly use the laparoscopic OCT to detect the intestinal tumor margin and lymph nodes during opera

关 键 词：光学相干断层扫描 胃肠肿瘤 综述 

分 类 号：R735[医药卫生—肿瘤]