探头式共聚焦激光显微内镜在微创保胆手术中的应用

The application of confocal laser endomicroscopy in gallbladder-preserving surgery

目的:在内镜微创保胆手术(choledochoscopic gallbladder-preserving surgery,CGPS)中应用探头式共聚焦激光显微内镜(probe-based confocal laser endomicroscopy,pCLE)进行术中探查,评估pCLE诊断胆囊疾病的应用价值。方法:选取2019年9月~2020年7月28例拟行CGPS+pCLE患者,术中经胆道镜孔道送入pCLE探头置于胆囊黏膜进行扫查,正常胆囊于典型部位活检,胆囊良性病变行电切术,肿瘤性病变行胆囊切除。术中pCLE诊断与术前影像学、术后病理学诊断对照,判断pCLE诊断胆囊疾病的准确率,评估pCLE在CGPS中的应用价值;结合病理诊断结果,总结不同胆囊疾病中pCLE特点,为CGPS提供准确、高效的评估指标。结果:28例患者共行29组pCLE检查,获得29组病理诊断,包括28块胆囊组织及1块小网膜肿物组织。pCLE术中诊断与术后病理学诊断进行对照,二者诊断符合率达100%。正常黏膜与胆囊不同疾病黏膜具有很高的辨识度,微血管直径、微血管走行、细胞直径、细胞形态、腺体形态等指标在正常胆囊黏膜与胆固醇性息肉、腺瘤性息肉、腺癌等疾病间差异有统计学意义(P<0.05)。结论:pCLE在CGPS术中诊断胆固醇性息肉、腺瘤性息肉、腺癌等胆囊疾病方面具有无创、实时、快速、准确的特点,具有潜在的应用价值。

Objective:Using probe-based confocal laser endomicroscopy(pCLE)as intraoperative diagnosis in Choledochoscopic gallbladder-preserving surgery(CGPS),to evaluate the application value of pCLE in the diagnosis of gallbladder diseases.Method:All patients were referred to The Second Affiliated Hospital of Baotou Medical College,between October 2019 and July 2020.Duaring the CGPS,a pCLE probe was put in gallbladder lumen through choledochoscope channel to scan the gallbladder mucosa.The normal gallbladder mucosa were biopsied from the typical sites,the benign gallbladder lesions underwent electroresection,and the neoplastic gallbladder lesions underwent cholecystectomy.The intraoperative pCLE diagnosis was compared with preoperative imaging diagnosis and postoperative pathological diagnosis to determine the accuracy of pCLE in the diagnosis of gallbladder disease and evaluate the application value of pCLE in CGPS.Combined with the pathological diagnosis results,the characteristics of pCLE in different gallbladder diseases were summarized to provide accurate and efficient evaluation indexes for CGPS.Result:Among the 28 patients,including 28 gallbladder tissues and 1 small omentum mass tissue.A total of 29 groups were pCLE examined,and 29 groups were pathologically diagnosed.Intraoperative diagnosis of pCLE was compared with the postoperative pathological diagnosis,and the coincidence rate of the two diagnoses reached 100.0%.The normal mucosa and the mucosa of different diseases on the gallbladder have a high degree of identification,and the indexes of microvessel diameter,microvessel run,cell diameter,cell morphology and gland morphology are different between the normal gallbladders,cholesterol polyps,adenomatous polyps and adenocarcinoma.Conclusion:pCLE can be used to diagnose gallbladder diseases such as cholesterol polyps,adenomatous polyps and adenocarcinoma.pCLE diagnosis is noninvasive,real-time,rapid and accurate,and has potential application value in CGPS as an intraoperative diagnosis.