多光谱成像在膀胱镜检查中应用的临床意义

Clinical significance of multispectral imaging in cystoscopic examination

目的探讨不同光谱条件下膀胱镜检查的成像特点及其临床意义。方法2011年5月至2013年5月采用随机化分组表选取膀胱肿瘤患者16例、良性前列腺增生患者14例、膀胱及下尿路正常的上尿路疾病患者5例行普通光谱条件下的膀胱镜检查。男31例，女4例。年龄43～84岁，平均56岁。35例均行膀胱CT检查，膀胱肿瘤患者行TURBT及病理检查以明确诊断。硬膜外麻醉下，采用多光谱内镜光源与27F电切镜连接，经尿道置入膀胱，观察在白光、紫外光（401．0nm）、蓝光（467．6nm）、绿光（534．2nm）、红光（660．6nm）、近红外光（763-8nm）等6种光谱照射条件下，膀胱腔的可视度以及膀胱黏膜与黏膜下层的移动度。观察膀胱黏膜和膀胱肿瘤的表面色泽、血管密度、血管清晰度、血管立体状结构等特征。结果本组35例，紫外光和近红外光照射时，视频显示器不显像；绿光照射膀胱黏膜时，能清晰显示黏膜表面和黏膜下层血管，并呈立体网状结构；蓝光照射时，黏膜表面和黏膜下层的血管密度增加，但清晰度较差；红光照射时，黏膜均呈红色，不能区分黏膜下血管和黏膜。16例TURBT术中，7例肿瘤切除至黏膜下层时，白光下见结构完整的浅表肌层，绿光下看不到血管，术后病理证实为T1期；6例绿光下能够识别黏膜血管与肿瘤血管间的结构关系，术后病理证实为Ta期；3例切除肉眼所见肿瘤后，于白光观察正常的膀胱黏膜处，绿光下发现点状血管形态结构异常，术后病理证实为Tis期。结论不使用荧光染料，紫外光、蓝光、红光和近红外光在膀胱镜检查中没有使用价值。绿光（534．2nm）照射正常膀胱黏膜时，黏膜表面和黏膜下层血管共同呈现立体网状结构，有助于识别微小的肿瘤和实时分析肿瘤的浸润深度。

Objective To explore the imaging characteristics and clinical value of multispectral cys- toseopy. Methods From May 2011 to May 2013, 31 male and 4 female patients were included in this study, including benign prostatic hyperplasia in 14 patients, bladder tumor in 16 patients, upper urinary tract disease alone in 5 patients. The mean age in this group was 56 years （range 43 to 84 years）. All patients accepted the bladder CT scan for diagnosis. TURBT procedure and pathological examination were per- formed in those patients with bladder tumor. Under the epidural anesthesia, the 27 F resectoseope was insert- ed to bladder through the urethra. Then, the conventional light source was replaced by multispeetral endo- scope light source. The white light, UV-light （401.0 nm）, blue light （467.6 nm）, green light （534.2 nm） , red light （660.6 nm） , and near-infrared light （763.8 nm） were used, subseqently. Meanwhile, the following data were recorded, such as the visibility of bladder cavity, the color of bladder tumors and bladder mucosa, the density of blood vessels, three-dimensional structure of blood vessels, the mobility between mucosa and submueosa. Results When UV-light and near-infrared light irradiated bladders, there were not any imaging on monitor. However, the bladder mucosa and submueosa blood vessels were showed clearly and constituted the three-dimensional blood vessel network when using green light. The density of blood vessels in mucosal and submucosal layer was increased but less clarity when using blue light. The mucosal surface was covered in red when using red light, which vascular and mucosal can not able to be distinguished. Among 16 patients who were accepted the TURBT procedure, seven cases with T1 stage tumors were resected to the submucosa by TURBT. The superficial muscle layer with integrity structure could be observed under white light. While, blood vessels were not appeared when using green light. In six cases with To stage tumors, the clear connection of blood spots between mucous blood vessels and the blood vessel from the tumor could be observed under the green-light conditions. In three patients with Tis stage tumors, the mucosal blood vessels were normal under the white-light after tumor resection. However, structural disorder could be found under the green-light, which should be highly suspected as Tis stage tumors. Conclusions Without any photosensitizer or fluorescent dye, tumor blood vessels and bladder mucosal vascular can be showed under the green light. This technique is useful for identify the minimal tumor and evaluate the carcinoma infiltrated depth.