激光共聚焦内镜技术在尿路上皮肿瘤诊断中的应用进展

Progress in application of confocal laser endomicroscopy in diagnosis of urothelial tumors

激光共聚焦内镜(CLE)技术是最近新兴的显微成像技术之一,可以在腔内结合普通内镜,通过激光激发产生人体局部组织实时、原位的超显微图像。CLE技术早期被应用于胃肠道肿瘤的内镜诊断中。随着技术的发展,探针口径不断缩小,被应用于泌尿外科尿路上皮肿瘤的内镜诊断领域。CLE需要联合荧光染色剂成像,早期采用膀胱荧光素作为荧光剂,随着技术逐渐发展,己基氨基乙酰丙酸盐被用于延长作用时间,使观察更加方便。CLE可以有效辨别乳头状肿瘤、扁平肿瘤、红斑以及正常黏膜与肿瘤病变之间的边界。CLE通过特殊染色和激光成像,可以提供待检组织实时、高分辨率、一定穿透深度的微米级组织图像,具有较高的准确度和特异度,有取代传统病理H&E染色成为尿路上皮肿瘤确诊依据的潜力。但是,CLE不建议与荧光膀胱镜联用,且具有成像范围较小、依赖稳定表面接触等缺点,需要更加先进的成像技术、信号传输技术与采样稳定技术支持。

Confocal laser endomicroscopy(CLE)is a newly emerging microscopic imaging technology.It can be combined with ordinary endoscopes in cavities to generate real-time,in situ ultramicroscopic images of human body tissues by laser excitation.CLE was early applied to the endoscopic diagnosis of gastrointestinal tumors.With the development of technology,the diameter of the probe has been continuously reduced,and it has been used in the endoscopic diagnosis of urothelial tumors.During CLE imaging,a fluorescent stain is needed.In the past,bladder fluorescein was used as a fluorescent agent.Later,hexylaminolevulinic acid was used to prolong the imaging time.CLE can effectively distinguish papillary tumors,flat tumors,and erythema,as well as the boundary between normal mucosa and tumor lesions.Through special staining and laser imaging,CLE can provide real-time,high-resolution,micron-level images of the tissue to be examined.It has high accuracy and specificity,and may replace traditional pathological H&E staining to become a diagnostic tool for urothelial tumors.However,CLE is not recommended for use with fluorescent cystoscopy,and has the disadvantages of a small imaging range and reliance on stable surface contact.Thus,more advanced imaging technology,signal transmission technology,and sampling stabilization technology are required to provide support for CLE.