Medical Endoscope Black Technology (5) Confocal Laser Microendoscopy (CLE)

Confocal Laser Endoscopy (CLE) ndi luso lopambana la "mu vivo pathology" m'zaka zaposachedwa, lomwe limatha kukwaniritsa kuyerekezera kwa nthawi yeniyeni ya maselo pakukulitsa nthawi 1000 pakuwunika kwa endoscopic, kusinthiratu njira yodziwira matenda a "biopsy choyamba → matenda pambuyo pake". Pansipa pali kusanthula kwakuya kwaukadaulo wotsogolaku kuchokera ku miyeso 8:

1.Mfundo zamakono ndi zomangamanga za dongosolo

Core imaging mechanism:

Mfundo ya ma confocal Optics: Mtengo wa laser umayang'ana mwakuya kwinakwake (0-250 μ m), kulandira kuwala kokha kowonekera kuchokera mundege yoyang'ana ndikuchotsa kusokoneza.

Kujambula kwa fluorescence: kumafuna jakisoni wolowera m'mitsempha/kupopera mbewu mankhwalawa kwamtundu wa fulorosenti (monga sodium fluorescein, acridine yellow)

Njira yosanthula:

Kusanthula malo (eCLE): Kusanthula kwa mfundo, kusanja kwakukulu (0.7 μ m) koma kuthamanga pang'onopang'ono

Kusanthula kwapamtunda (pCLE): Kusanthula kofananira, kuthamanga kwa chimango (12fps) kuti muwone bwino

Kapangidwe kadongosolo:

Laser jenereta (488nm Blue Laser Mtundu)

Micro confocal probe (yokhala ndi mainchesi osachepera 1.4mm yomwe imatha kuyikidwa kudzera munjira za biopsy)

Chigawo chokonza zithunzi (kuchepetsa phokoso lenileni + kukonzanso kwa 3D)

AI yothandizira kusanthula gawo (monga kudziwikiratu kuperewera kwa ma cell a goblet)

2. Ubwino wopita patsogolo paukadaulo

3. Zochitika zachipatala zogwiritsira ntchito

Zizindikiro zazikulu:

Khansara ya m'mimba yoyambirira:

Khansara ya m'mimba: tsankho lenileni la m'mimba metaplasia / dysplasia (kulondola kwa 91%)

Khansara ya colorectal: gulu la ma glandular duct opens (gulu la JNET)

Matenda a pancreatic ndi gallbladder:

Kuzindikira kosiyana kwa benign ndi zoyipa za bile duct stenosis (sensitivity 89%)

Kujambula khoma lamkati la pancreatic cyst (kusiyanitsa ma IPMN subtypes)

Mapulogalamu ofufuza:

Kuwunika kwamphamvu kwamankhwala (monga kuwunika kwamphamvu kwa matenda a Crohn's mucosal kukonza)

Phunziro la Microbiome (kuyang'ana kugawa kwapakati kwa gut microbiota)

Zochitika zodziwika bwino:

(1) jakisoni wamtsempha wa fluorescein sodium (10% 5ml)

(2) Confocal kafukufuku kulankhula kukayikira mucosa

(3) Kuwona nthawi yeniyeni ya kapangidwe ka glandular / nyukiliya morphology

(4) AI idathandizira kuweruza kwa ma pit classification kapena Vienna grading

4. Kuyimira opanga ndi magawo azinthu

5. Mavuto aukadaulo ndi mayankho

Zolepheretsa zomwe zilipo:

Mapiritsi ophunzirira ndi otsetsereka: kuwongolera munthawi yomweyo kwa endoscopic ndi chidziwitso cha pathology (nthawi yophunzitsira> miyezi 6)

Yankho: Pangani mamapu oyezetsa a CLE (monga gulu la Mainz)

Zoyenda: Zotsatira za kupuma / zotumphukira zimakhudza mawonekedwe azithunzi

Yankho: Yokhala ndi ma aligorivimu achimalipiro osinthika

Kuchepetsa kwa fluorescent agent: Sodium fluorescein sangathe kuwonetsa tsatanetsatane wa cell cell

Mayendedwe opambana: Ma probe a molekyulu omwe amatsata (monga ma anti EGFR fluorescent antibodies)

Maluso ogwirira ntchito:

Z-axis scanning teknoloji: kuyang'ana kosanjikiza kwa kapangidwe ka mucosa iliyonse

Njira ya Virtual biopsy: kuyika chizindikiro madera osakhazikika ndikuyesa molondola

6. Kafukufuku waposachedwa

Kupambana Kwambiri mu 2023-2024:

Kusanthula kachulukidwe ka AI:

Gulu la Harvard limapanga makina opangira zithunzi a CLE (Gastroenterology 2023)

Kuzindikira mozama kwa kuchuluka kwa ma cell a goblet (kulondola 96%)

Multi Photon fusion:

Gulu la Germany limazindikira CLE + yachiwiri ya harmonic imaging (SHG) kuphatikiza mawonekedwe a collagen

Nano probe:

Chinese Academy of Sciences imapanga CD44 yolunjika ya dot probe (makamaka kulemba ma cell a khansa ya m'mimba)

Zotsatira za mayeso azachipatala:

Phunziro la PRODIGY: CLE motsogozedwa ndi ESD maginito opangira opaleshoni adakwera mpaka 98%

Kuyesa kwa CONFOCAL-II: Kuzindikira kwa pancreatic cyst kulondola 22% kuposa EUS

7. Zochitika Zachitukuko Zamtsogolo

Chisinthiko chaukadaulo:

Kupambana kwakukulu: STED-CLE ikwaniritsa <200nm kusamvana (pafupi ndi ma electron microscopy)

Kujambula kopanda zilembo: njira yotengera fluorescence / Raman kubalalitsidwa

Chithandizo chophatikizika: kafukufuku wanzeru wokhala ndi ntchito yophatikizika ya laser ablation

Kuwonjezera kwa Clinical Application:

Kuneneratu za mphamvu ya tumor immunotherapy (kuwonera kulowetsedwa kwa T cell)

Kuwunika kogwira ntchito kwa zotupa za neuroendocrine

Kuyang'anira koyambirira kwa kukana kwa chiwalo chomuika

8. Chiwonetsero cha milandu yeniyeni

Mlandu 1: Kuwunika kwa esophagus kwa Barrett

Kutulukira kwa CLE: glandular structural disorder+kutayika kwa nyukiliya polarity

Kuzindikira pompopompo: Highly dysplasia (HGD)

Tsatirani chithandizo: Chithandizo cha EMR ndi kutsimikizika kwapathological kwa HGD

Mlandu 2: Chilonda cham'mimba

Traditional endoscopy: mucosal congestion ndi edema (palibe zotupa zobisika zomwe zapezeka)

Chiwonetsero cha CLE: kuwonongeka kwa mapangidwe a crypt + fluorescein kutayikira

Chisankho Chachipatala: Kupititsa patsogolo Biological Therapy

Chidule ndi mawonekedwe

Ukadaulo wa CLE ukuyendetsa matenda a endoscopic munthawi ya "matenda a nthawi yeniyeni pama cell":

Nthawi yochepa (zaka 1-3): AI yothandizira machitidwe amachepetsa zotchinga zogwiritsira ntchito, mlingo wolowera umaposa 20%

Zaka zapakati (zaka 3-5): Zofufuza za mamolekyulu zimakwaniritsa chotupa chodziwika bwino

Nthawi yayitali (zaka 5-10): imatha kusintha ma biopsies ena

Tekinoloje iyi ipitiliza kulembanso malingaliro azachipatala a 'zomwe mukuwona ndizomwe mumazindikira', ndikukwaniritsa cholinga chachikulu cha 'in vivo molecular pathology'.