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

Confocal Laser Endoscopy (CLE) waa horumar "in vivo pathology" technology sannadihii la soo dhaafay, kaas oo gaari kara sawir-waqtiga dhabta ah ee unugyada ee weynaynta 1000 jeer inta lagu guda jiro baaritaanka endoscopic, kacaanka habka ogaanshaha dhaqameed ee "biopsy marka hore → pathology dambe". Hoos waxaa ku yaal falanqeyn qoto dheer oo ku saabsan farsamadan casriga ah ee 8 cabbir:

1.Mabaadi'da farsamada iyo qaab-dhismeedka nidaamka

Habka sawirka xudunta u ah:

Mabda'a indho-indheynta indhaha: Laydhka laysarka wuxuu diiradda saarayaa qoto dheer oo gaar ah (0-250 μm), isagoo helaya oo keliya iftiinka iftiimaya ee diyaaradda focal iyo baabi'inta faragelinta kala firdhisanaanta.

Sawirka fluorescence: wuxuu u baahan yahay duritaanka xididka/buufinta deegaanka ee wakiilada fluorescent (sida sodium fluorescein, jaalaha acridine)

Habka sawirka:

Sawirka dhibcaha (eCLE): Sawirka dhibic-dhibcaha, xallinta sare (0.7 μm) laakiin xawaare hooseeya

Sawirka dusha sare (pCLE): Iskaanka barbar socda, heerka jir ee degdega ah (12fps) ee u fiirsashada firfircoon

Halabuurka nidaamka:

Dhaliyaha Laser-ka (488nm Laser Buluuga Caadiga ah)

Baadhitaanka confocal-ka yar (oo leh dhexroorka ugu yar ee 1.4mm kaas oo la gelin karo kanaalada biopsy)

Cutubka habaynta sawirka (yaraynta qaylada wakhtiga-dhabta ah+dib u dhiska 3D)

Qaybta falanqaynta AI ee caawisay (sida aqoonsiga tooska ah ee yaraanta unugga goblet)

2. Faa'iidooyinka horumarka tignoolajiyada

3. Xaalado codsi caafimaad

Tilmaamaha asaasiga ah:

Kansarka hore ee dheefshiidka:

Kansarka caloosha: takoorka wakhtiga dhabta ah ee metaplasia/ dysplasia mindhicirka (qiimaha saxda ah 91%)

Kansarka mindhicirka: Kala soocidda daah-furnaanta marinnada qanjidhada (JNET classification)

Cudurada xameetida iyo xameetida:

Cilad-sheegid kala duwan ee stenosis xinjirta xameetida aan fiicneyn iyo malignant (dareenka 89%)

Sawirka gidaarka gudaha ee cystitiska ganaca (oo kala saara noocyada hoose ee IPMN)

Codsiyada cilmi baarista:

Qiimaynta waxtarka daroogada (sida la socodka firfircoon ee dayactirka xuubka cudurka Crohn)

Daraasada Microbiome (fiiri qaybinta boosaska microbiota mindhicirka)

Xaaladaha hawlgalka caadiga ah:

(1) Cirbadda xididka ee fluorescein sodium (10% 5ml)

(2) Baadhitaanka Confocal wuxuu la xidhiidhaa xabkaha laga shakiyo

(3) Daawashada waqtiga dhabta ah ee qaab dhismeedka qanjidhada / qaabdhismeedka nukliyeerka

(4) AI waxay caawisay xukunka ee kala soocida Pit ama qiimaynta Vienna

4. Matalaya soosaarayaasha iyo xuduudaha alaabta

5. Caqabado farsamo iyo xalal

Caqabadaha jira:

Qalooca waxbarashadu waa mid qotodheer: si isku mid ah u wanaajinta endoscopy iyo aqoonta pathology ayaa loo baahan yahay (muddada tababarka>6 bilood)

Xalka: Samee khariidadaha ogaanshaha CLE ee caadiga ah (sida kala soocidda Mainz)

Farshaxanka dhaqdhaqaaqa: Saamaynta neefsiga/saamaynta xun waxay saameeyaan tayada sawirka

Xalka: Waxaa lagu qalabeeyay algorithm magdhow firfircoon

Xaddidaadda wakiilka fluorescent: Sodium fluorescein ma muujin karto faahfaahinta nukleus unugga

Jihada horumarisa: Baadhitaannada molecular ee la beegsaday (sida ka hortagga EGFR fluorescent antibodies)

Xirfadaha hawlgalka:

Tignoolajiyada iskaanka dhidibka Z-axis: indho-indheynta lakabka ah ee qaab dhismeedka lakab kasta oo xabkaha ah

Istaraatiijiyad cad ka-qaadis ah: calaamadaynta meelaha aan caadiga ahayn ka dibna si sax ah u muunad

6. Horumarka cilmi baarista ee ugu dambeeyay

Horumarka xuduudaha 2023-2024:

Falanqaynta tirada AI:

Kooxda Harvard waxay horumarisay sawirka CLE habka dhibcaha tooska ah (Gastroenterology 2023)

Aqoonsiga qoto dheer ee barashada cufnaanta unugga goblet (saxa 96%)

Fiyuuska sawirka badan:

Kooxda Jarmalku waxay xaqiiqsadeen CLE + sawir-qaadista labaad ee is-waafajinta (SHG) isku darka qaabka kolajka

Baadhitaanka Nano:

Akadeemiyada Sayniska Shiinaha ayaa soo saartay CD44 bartilmaameedka tirada dhibcaha (gaar ahaan calaamadaynta unugyada asliga ee kansarka caloosha)

Heerarka tijaabada caafimaad:

Daraasadda PRODIGY: CLE ay hagto ESD heerka qalliinka ee xad-dhaafka ah ayaa kordhay ilaa 98%

Imtixaanka CONFOCAL-II: saxnaanta ogaanshaha cyst ee ganaca 22% ka sarreeya EUS

7. Isbeddellada Horumarineed ee Mustaqbalka

Kobcinta farsamada:

Horumarka xallinta sare: STED-CLE waxay gaadhay <200nm xallinta (oo u dhow microscopy elektarooniga ah)

Sawir aan la calaamadin: farsamo ku salaysan fluorescence/Raman kala firdhiso

Daawaynta isku dhafan: baadhitaan caqli-gal ah oo leh shaqeyn isku-dhafan oo laysarka ah

Kordhinta codsiga kiliinikada:

Saadaasha waxtarka difaaca jirka ee buro (fiiri galitaanka unugyada T)

Qiimaynta shaqeynta ee burooyinka neuroendocrine

La socodka hore ee falcelinta diidmada xubinta taranka

8. Muujinta kiisaska caadiga ah

Kiiska 1: Kormeerka hunguriga Barrett

Daahfurka CLE: khalkhalka qaabdhismeedka qanjidhada+luminta cirifka nukliyeerka

Cilad degdeg ah: dysplasia sare (HGD)

Dabagalka daawaynta: Daawaynta EMR iyo xaqiijinta cudur-sidaha ee HGD

Kiis 2: Colitis Ulcerative

Endoscopy dhaqameed: ciriiri xuubka iyo bararka (ma jiraan dhaawacyo qarsoon oo la helay)

Muujinta CLE: burburinta naqshadaha crypt + daadinta fluorescein

Go'aanka Kiliinikada: Kor-u-qaadista Daaweynta Nafleyda

Soo koobid iyo aragti

Tiknoolajiyada CLE waxay kaxaynaysaa ogaanshaha endoscopic ee xilliga "pathology-waqtiga dhabta ah ee heerka gacanta":

Muddada gaaban (1-3 sano): Nidaamyada caawiya AI waxay hoos u dhigaan caqabadaha isticmaalka, heerka dhexgalka ayaa ka sarreeya 20%

Muddada dhexe (3-5 sano): Baarayaasha molecular waxay gaaraan calaamadeyn gaar ah oo buro ah

Muddada dheer (5-10 sano): waxa laga yaabaa inay bedesho qaar ka mid ah shaybaarada ogaanshaha

Farsamadani waxay sii wadi doontaa inay dib u qorto jaantuska caafimaad ee 'waxa aad aragto waa waxa aad baadhayso', ugu dambayntii waxay gaadhaysaa yoolka ugu dambeeya ee 'in vivo molecular pathology'.