消化道早癌的诊断3__培训课件.pptxVIP

消化道早癌的内镜诊断谭庆华四川大学华西医院概 述诊 断治 疗发现早癌的内镜诊断技术超声内镜。共聚焦显微内镜。自体荧光内镜光学相干断层成像术细胞内镜蓝激光成像白光内镜检查。染色内镜检查。白光放大（ME）。染色+放大。ME+NBI (magnified endoscopy)。活检白光内镜发现早癌的前提理想的消化内镜术前检查的准备：清理视野，抵制蠕动。严格的质量控制。时刻准备发现早癌的警觉性。特殊、小病变，可借助特殊内镜诊断方法。活检。一、染色内镜最常用的染料：碘染色：食管黏膜染色。0.1-0.4%靛胭脂：对比性染料，常用于腺瘤。0.1-0.2%美蓝(亚甲蓝)：吸收性，常用于腺瘤。0.05%结晶紫（龙胆紫）：吸收性，常用于侵袭性病变染色。在病变表面滴数滳，然后再用温水冲洗。最好用链霉蛋白酶。表1消化内镜下常用染料?染料类型被染对象染色原理阳性颜色临 床 应 用Lugol’s碘液(碘+碘化钾)磷状上皮内的糖原非角化上皮结合碘深棕色正常食管磷状上皮着色。食管磷状细胞癌黏膜、Barrett食管黏膜、柱状上皮和食管炎黏膜均不着色。亚甲蓝肠道上皮细胞，肠化上皮细胞吸收入上皮细胞内蓝色食管和胃的肠化上皮、早期胃癌上皮和正常肠道上皮着色。十二指肠内化生的胃上皮不着色。甲苯胺蓝胃或肠内的柱状上皮细胞胞核差色自由扩散入细胞蓝色食管磷状细胞癌上皮和Barret’s食管中的化生上皮着色刚果红胃内泌酸细胞当pH3.0时变色变为深蓝或黑色泌酸的胃上皮变色，包括异位胃黏膜上皮。胃癌上皮细胞不变色。酚红感染HP的胃上皮细胞由于HP周边有“氨云”，局部呈碱性而便酚红变色由黄变红诊断胃内HP的感染及其分布情况。靛胭脂细胞不着色沉积于上皮表面的低凹处，勾勒出病变形态。蓝色全消化道黏膜均可使用。Conventional white light imagingIndigo carmine chromoendoscopyIndigo carmineIndigo carmine靛胭脂：中央凹陷白光内镜：7mm扁平息肉样隆起结晶紫：结构消失，侵及黏膜下层。 二、特殊光谱及放大内镜C-WLI: 20-40倍ME:80-170倍Magnifying endoscopy (ME)Narrow band imagingEP, epithelium; LPM, lamina propria mucosae; MM, muscularis mucosae; SM, submucosa; PM, proper muscle; M1, cancer is limited epithelium; M2, cancer invades LPM but does not reach MM; M3, cancer invasion reaches MM; SM, submucosally invasive cancerNBI imaging of a lesion of IPCL type III. NBI imaging of a lesion of IPCL type IV regional atrophic mucosa or low grade intraepithelial neoplasia high-grade intraepithelial neoplasia：Tis This pattern is called IPCL-V1. IPCL-V1 includes four major characteristic morphological changes of IPCL: dilation, meandering, irregular caliber, and figure variation. T1a.This is typical image of intrapapillary capillary loop (IPCL)-V3. Cancer invasion depth was M3 (muscularis mucosae: T1a).Large white arrows point to large tumor vessel (IPCL-VN). The striking morphological feature is its extra-large diameter. Note the difference of vessel caliber between IPCL-V3 (small white arrow) and VN (large white arrow: T1b or deeper). V: microvascular pattern? Subepithelial capillary (SEC)? Collecting venule (CV)? P