共聚焦显微内镜对临床难以确诊的皮革胃的诊断价值

Diagnostic value of confocal laser endomicroscopy in difficult cases of linitis plastica

目的探索共聚焦显微内镜(CLE)对临床难以确诊的皮革胃病例的诊断价值。方法收集2009年～2011年因胃黏膜病变行CLE检查的患者317例。CLE检查过程中使用经静脉注射的10%荧光素钠溶液作为荧光剂,术后行导向病理活检。对CLE无法确诊的病例行腹部薄层增强CT扫描,对符合手术指征者行外科手术。将普通胃镜、CLE检查及活检病理结果进行比较分析。结果总共13例临床确诊为皮革胃的患者接受了CLE检查,所有患者术前均曾接受包括常规内镜及活检病理在内的辅助检查,病理均未确诊胃癌。单纯根据CLE图像诊断皮革胃的准确率为76.9%(10/13),CLE导向活检阳性率84.6%(11/13)。对皮革胃患者的CLE图像分析显示,腺体排列紊乱伴明显炎症反应、荧光素钠大量渗出、高度异型腺体或成片排列的大型暗色细胞、腺上皮或间质中大型浅色细胞、间质中异常扭曲异型的阳性率分别为84.6%、76.9%、76.9%、46.1%与7.7%。结论 CLE检查及CLE导向活检术是提高皮革胃诊断正确性的有效方法。

Objective To evaluate the diagnostic value of eonfocal laser endomicroseopy （CLE） in difficult cases in diagnosis of linitis plastica （LP）. Methods Three hundred and seventeen patients with gastric mucosal lesion who un- derwent CLE between June 2009 and March 2011 were reviewed. Intravenous fluoreseein sodium in a concentration of 10% was used in the procedure and targeted biopsies were taken. Enhanced multiple slice CT was processed in cases when CLE failed to confirm the diagnosis of LP. Patients were referred to surgery when necessary. Results Thirteen patients in which LP was later confirmed underwent CLE. Routine upper GI endoscopy and biopsy were performed on all patients prior to CLE and failed to confirm the diagnosis. Diagnostic rate of LP solely based on CLE images was 76.9% （10/13） , and positive rate of CLE-assisted targeted biopsy was 84. 6% （ 11/13 ）. Analysis based on CLE images showed that the positive rates of glands derangement with severe inflammation, increased exudation of fluorescin, severely atypic tumor glands or clustered large dark cells, large bright cells in epithelium or lamina propria, tortuous microves- sels in lamina propria were 84.6% , 76.9% , 76.9% , 46.1% and 7.7% , respectively. Conclusion CLE and CLE- assisted targeted biopsy are effective methods to enhance the diagnostic accuracy of LP.