消化道早癌的内镜诊断 ppt课件

S: microsurface pattern • Marginal crypt epithelium (MCE) • Crypt opening (CO) • Intervening part (IP) between crypts
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A
B
C
D
MNBI, magnifying endoscopy with narrow-band imaging; LBC, light blue crest
marginal crypt epithelium;
(D)Atrophic gastritis.
collecting volume
Yao K.22Ann Gastroenterol. 2013;26(1):11-22. ppt课件
(A) C-WLI :erosion (B) M-NBI: a regular microvascular
vessel caliber between IPCL-V3 (small white arrow) and VN (large white
arrow: T1b or deeper).
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V: microvascular pattern • Subepithelial capillary (SEC) • Collecting venule (CV) • Pathological microvessels (MV)
LPM but does not reach MM; M3, cancer invasion reaches MM; SM, submucosally
invasive cancer
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ቤተ መጻሕፍቲ ባይዱ6
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NBI imaging of a lesion of IPCL type III.
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。
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Conventional white light imaging
Indigo carmine chromoendoscopy
This pattern is called IPCL-V1. IPCL-V1 includes four major characteristic
morphological changes of IPCL: dilation, meandering, irregular caliber, and
regional atrophic mucosa or low grade intraepithelial neoplasia
NBI imaging of a lesion of IPCL type IV high-grade intraepithelial neoplasia：Tis
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EP, epithelium; LPM, lamina propria mucosae; MM, muscularis mucosae; SM,
submucosa; PM, proper muscle; M1, cancer is limited epithelium; M2, cancer invades
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Indigo carmine
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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。
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Indigo carmine
靛胭脂：中央凹陷
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二、特殊光谱及放大内镜
Narrow band imaging
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C-WLI: 20-40倍 ME: 80-170倍
Magnifying endoscopy (ME)
SECN, RAC, CO, MCE, CV,
subepithelial capillary network;
regular arrangement of collecting venules; (A, B) Normal gastric body mucosa.
crypt-opening;
(C) Helicobacter pylori-associated gastritis.
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Large white arrows point to large tumor vessel (IPCL-VN). The striking
morphological feature is its extra-large diameter. Note the difference of
pattern and a regular microsurface pattern with light blue crest. (C) chronic gastritis with intestinal metaplasia
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(A) C-WLI: 轻微凹陷。 (B) M-NBI：irregular MV
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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。
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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。
figure variation. T1a.
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This is typical image of intrapapillary capillary loop (IPCL)-V3. Cancer invasion depth was M3 (muscularis mucosae: T1a).
消化道早癌的内镜诊断
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诊断
概述
治疗
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发现早癌的内镜诊断技术
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
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