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背景:内镜黏膜下剥离术(ESD)目前已广泛应用于胃癌前病变和早期胃癌的根治。普通白光内镜检查难以发现ESD术后的残留和复发病变,而共聚焦激光显微内镜(CLE)可对黏膜病变作出实时体内组织学诊断而无需活检。目的:探讨CLE在ESD术后残留和复发病变诊断中的应用价值。方法:连续纳入2009年6月～2011年12月上海仁济医院因胃上皮内瘤变或早期胃癌而接受ESD治疗的患者,分别于术后1、3、6个月行CLE随访。综合首次ESD、CLE复查发现病变后追加的手术切除以及CLE活检病理结果作出最终诊断,并与CLE诊断进行对照。结果:共20例行ESD治疗者纳入研究,所有患者均完成CLE随访。ESD术后1个月CLE复查发现2例残留病变,术后6个月CLE复查发现1例复发病变,CLE诊断均为高级别上皮内瘤变(HGIN)。追加剖腹手术病理诊断2例残留病变为HGIN,1例复发病变为早期分化型腺癌。其余17例患者3次CLE复查均未见病变残留或复发。结论:CLE检查可准确诊断ESD术后残留和复发病变,对ESD术后内镜随访具有重要价值。
Background: Endoscopic submucosal dissection (ESD) has been widely used in the treatment of gastric precancerous lesions and early gastric cancer. Conventional white light endoscopy is difficult to detect post-ESD residual and recurrent lesions, whereas confocal laser endomicroscopy (CLE) allows real-time in vivo histological diagnosis of mucosal lesions without biopsy. Objective: To investigate the value of CLE in the diagnosis of residual and recurrent lesions after ESD. Methods: Patients with ESD treated by intra-gastric intraepithelial neoplasia or early gastric cancer in Renji Hospital of Shanghai from June 2009 to December 2011 were included in the study. Follow-up was performed at 1, 3 and 6 months after operation. Based on the first ESD and CLE examinations, additional surgically resected lesions and CLE biopsy results were used to make the final diagnosis and compared with the CLE diagnosis. Results: A total of 20 ESD patients were enrolled in the study. All patients were followed up for CLE. One month after ESD, 2 cases of residual lesions were found in the review of CLE. One case of recurrent lesions was found after 6 months of CLE. The diagnosis of CLE was high grade intraepithelial neoplasia (HGIN). Additional laparotomy pathological diagnosis of 2 cases of residual disease HGIN, 1 case of recurrent lesions of early differentiated adenocarcinoma. The remaining 17 patients 3 times CLE review showed no lesions or recurrence. Conclusion: CLE can accurately diagnose the residual and recurrent lesions after ESD, which is of great value for endoscopic follow-up after ESD.