Ubuvuzi Endoskopi Yumukara (5) Laser Microendoscopy (CLE)

Confocal Laser Endoscopy (CLE) ni intambwe "mu buhanga bwa vivo patology" mu myaka yashize, ishobora kugera ku mashusho nyayo y’ingirabuzimafatizo ku ntera inshuro 1000 mu gihe cyo kwisuzumisha endoskopi, bigahindura uburyo bwo kwisuzumisha bwa "biopsy mbere → patologiya nyuma". Hasi nisesengura ryimbitse ryubu buhanga bugezweho kuva 8:

1.Amahame ya tekiniki nuburyo bwububiko

Uburyo bukoreshwa mu gufata amashusho:

Ihame rya optique optique: Urumuri rwa lazeri rwibanze ku burebure bwihariye (0-250 μ m), rwakira gusa urumuri rugaragara ruva mu ndege yibanze kandi rukuraho kwivanga.

Kwerekana amashusho ya Fluorescence: bisaba gutera inshinge / gutera imiti ya fluorescent (nka sodium fluorescein, acridine umuhondo)

Uburyo bwo Gusikana:

Gusikana ingingo (eCLE): Ingingo kumurongo wo gusikana, gukemura cyane (0.7 μ m) ariko umuvuduko gahoro

Gusikana hejuru (pCLE): Gusikana kuburinganire, igipimo cyihuta (12fps) kugirango turebe imbaraga

Ibigize sisitemu:

Amashanyarazi ya Laser (488nm Ubururu bwa Laser busanzwe)

Micro conocal probe (ifite byibura diameter ya 1,4mm ishobora kwinjizwa binyuze mumiyoboro ya biopsy)

Igice cyo gutunganya amashusho (kugabanya urusaku nyarwo + kwiyubaka 3D)

AI yafashijwe gusesengura module (nko kumenyekanisha mu buryo bwikora ibura rya selile)

2. Ibyiza byiterambere byikoranabuhanga

3. Ibisabwa byo kwa muganga

Ibimenyetso nyamukuru:

Kanseri yo mu gifu hakiri kare:

Kanseri yo mu gifu: ivangura nyaryo rya metaplasia yo munda / dysplasia (igipimo cyukuri 91%)

Kanseri yibara: gutondekanya imiyoboro ya glandular (JNET classification)

Indwara ya Gallbladder n'indwara zifata pancreatic:

Gutandukanya itandukaniro rya benigne na malignant bile duct stenosis (sensitivite 89%)

Kwerekana urukuta rwimbere rwa pancreatic cyst (gutandukanya insimburangingo ya IPMN)

Porogaramu y'ubushakashatsi:

Isuzumabushobozi ryibiyobyabwenge (nko gukurikirana imbaraga zo gusana indwara ya Crohn)

Ubushakashatsi bwa Microbiome (kwitegereza ikwirakwizwa rya microbiota yo munda)

Ibikorwa bisanzwe:

(1) Gutera inshinge za sodium ya fluorescein (10% 5ml)

(2) Conocal probe ihuza mucosa ikekwa

(3) Igihe nyacyo cyo kureba imiterere ya glandular / morphologie

(4) AI yafashije guca imanza zo mu byobo cyangwa amanota ya Vienne

4. Guhagararira abakora ibicuruzwa nibipimo byibicuruzwa

5. Ibibazo bya tekiniki nibisubizo

Inzitizi ziriho:

Kwiga umurongo birakomeye: icyarimwe kumenya ubumenyi bwa endoskopi hamwe nubumenyi bwa patologiya birakenewe (igihe cyamahugurwa> amezi 6)

Igisubizo: Tegura amakarita asanzwe ya CLE yo gusuzuma (nka Mainz classique)

Ibikoresho byimuka: Ingaruka zubuhumekero / peristaltike zigira ingaruka kumiterere yamashusho

Igisubizo: Bifite ibikoresho byindishyi zingirakamaro algorithm

Imikoreshereze ya Fluorescent: Sodium fluorescein ntishobora kwerekana ibisobanuro birambuye kuri selile

Icyerekezo cyiterambere: Intego ya molekuliyumu igamije (nka antibodies anti-EGFR fluorescent)

Ubuhanga bwo gukora:

Z-axis yo gusikana tekinoroji: kureba neza imiterere ya buri gice cya mucosa

Virtual biopsy stratégie: kuranga ahantu hadasanzwe hanyuma ugatoranya neza

6. Amajyambere agezweho yubushakashatsi

Iterambere ryambukiranya imipaka muri 2023-2024:

Isesengura ryinshi rya AI:

Ikipe ya Harvard itezimbere CLE ishusho sisitemu yo gutanga amanota (Gastroenterology 2023)

Kwiga byimbitse byerekana ubucucike bwa goblet (ubunyangamugayo 96%)

Multi Photon fusion:

Ikipe y'Ubudage yamenye CLE + ya kabiri ihuza amashusho (SHG) hamwe no kureba imiterere ya kolagen

Nano probe:

Ishuri Rikuru ry'Ubushinwa ryateguye CD44 igamije kwipimisha akadomo (cyane cyane kuranga kanseri yo mu gifu)

Ibipimo ngenderwaho byo kugerageza:

Ubushakashatsi bwa PRODIGY: CLE yayoboye ESD yo kubaga margin igipimo kibi cyiyongereye kugera kuri 98%

Ikizamini cya CONFOCAL-II: pancreatic cyst kwisuzumisha neza 22% kurenza EUS

7. Iterambere ry'ejo hazaza

Ubwihindurize mu ikoranabuhanga:

Iterambere ryiza cyane: STED-CLE igera kuri <200nm ikemurwa (hafi ya microscopi ya electron)

Kwerekana amashusho atemewe: tekinike ishingiye kuri fluorescence idahwitse / Raman ikwirakwiza

Ubuvuzi bwuzuye: iperereza ryubwenge hamwe nibikorwa bya laser byo gukuraho

Kwagura porogaramu ivura:

Guhanura ibibyimba bikingira indwara (kwitegereza T selile yinjira)

Isuzuma ryimikorere yibibyimba bya neuroendocrine

Gukurikirana hakiri kare reaction yo kwangwa ingingo

8. Kwerekana imanza zisanzwe

Urubanza 1: Gukurikirana Esophagus ya Barrett

CLE kuvumbura: imiterere ya glandular imiterere + gutakaza polarite ya kirimbuzi

Gusuzuma ako kanya: Dysplasia cyane (HGD)

Kurikirana ubuvuzi: Kuvura EMR no kwemeza indwara ya HGD

Ikiburanwa cya 2: Indwara ya kolite

Endoskopi gakondo: kunanuka kwa mucosal na edema (nta bisebe byihishe biboneka)

CLE kwerekana: gusenya ibyubatswe byubaka + fluorescein kumeneka

Icyemezo cya Clinical: Kuzamura Ubuvuzi bwa Biologiya

Incamake n'ibitekerezo

Ikoranabuhanga rya CLE ritera kwisuzumisha endoskopique mugihe cy "igihe nyacyo cya patologiya kurwego rwa selire":

Igihe gito (1-3 ans): AI ifasha sisitemu kugabanya inzitizi zikoreshwa, igipimo cyinjira kirenga 20%

Igihe giciriritse (3-5 ans): Molecular probe igera kumyanya yihariye

Igihe kirekire (5-10 ans): irashobora gusimbuza biopsies zimwe na zimwe

Iri koranabuhanga rizakomeza kwandika paradigima yubuvuzi y '' ibyo ubona aribyo usuzuma ', amaherezo igera ku ntego nyamukuru ya' muri vivo molecular pathology '.