CAJ | 학술논문

目的探讨共聚焦激光显微内镜检查(CLE)对胃非隆起性病变良、恶性的鉴别诊断价值.方法对37例常规内镜发现的胃非隆起型病变患者行CLE检查.静脉注射荧光素钠后对病变区域进行观察,然后进行靶向活检.对CLE或靶向活检病理诊断为恶性病变者进行内镜或手术治疗,术后对整块标本进行病理学检查；对良性患者予规范药物治疗并每隔3个月复查胃镜,直至病变愈合.结果 CLE诊断癌性病变11例,良性病变26例.靶向活检病理证实CLE诊断的11例癌变者中10例为癌,l例为良性；26例良性者中1例为癌,余皆为良性.共12例接受切除治疗(3例内镜治疗,9例外科手术),术后病理学证实与靶向活检病理诊断完全一致.良性者随访中未发现有恶变,经平均3.16(3.58±1.20)个月的内镜随访,病变均愈合.CLE对胃非隆起性病变癌变诊断的灵敏度、特异度和准确度分别为90.9％、96.2％和90.9％,阳性预测值和阴性预测值分别为90.9％和96.2％；CLE与组织学检查的Kappa值为0.871.结论 CLE对胃非隆起型病变具有较高的诊断价值,将有望替代活检病理做出实时组织学诊断.
목적 탐토공취초격광현미내경검사(CLE)대위비륭기성병변량、악성적감별진단개치.방법 대37례상규내경발현적위비륭기형병변환자행CLE검사.정맥주사형광소납후대병변구역진행관찰,연후진행파향활검.대CLE혹파향활검병리진단위악성병변자진행내경혹수술치료,술후대정괴표본진행병이학검사；대량성환자여규범약물치료병매격3개월복사위경,직지병변유합.결과 CLE진단암성병변11례,량성병변26례.파향활검병리증실CLE진단적11례암변자중10례위암,l례위량성；26례량성자중1례위암,여개위량성.공12례접수절제치료(3례내경치료,9예외과수술),술후병이학증실여파향활검병리진단완전일치.량성자수방중미발현유악변,경평균3.16(3.58±1.20)개월적내경수방,병변균유합.CLE대위비륭기성병변암변진단적령민도、특이도화준학도분별위90.9％、96.2％화90.9％,양성예측치화음성예측치분별위90.9％화96.2％；CLE여조직학검사적Kappa치위0.871.결론 CLE대위비륭기형병변구유교고적진단개치,장유망체대활검병리주출실시조직학진단.
Objective To discuss the differential diagnostic value of confocal laser endomicroscopy (CLE)for benign and malignant non-protruding gastric lesions.Methods A total of 37 patients with nonprotruding gastric lesions diagnosed by conventional gastroscopy underwent CLE.Fluorescein sodium was intravenously injected,and target biopsy was obtained.Malignant lesionss diagnosed with CLE or biopsy were treated by endoscopy or surgery.Patients with benign lesions were give routine medication and followed up every 3 months until the lesions were cured.Results CLE diagnosed 11 malignant and 26 benign lesions.However,1 of 11 cancers was confirmed as benign by histopathology,while 1 of 26 benign lesions was confirmed cancer.Lesions in 12 patients were resected,with 3 by endoscopy,and 9 by surgery,and findings of post-operative pathology were consistent with those of target biopsy.No malignancy was found during the follow-up of benign lesions,and all lesions were healed after 3.16(3.58 ± 1.20)months.The sensitivity,specificity,and accuracy of CLE in diagnosis of malignant non-protruding gastric lesion were 90.9％,96.2％,and 90.9％,respectively.The positive and negative predictive values were 90.9％ and 96.2％,respectively.The Kappa value of CLE and histopathology was 0.871.Conclusion CLE is of significant value for the diagnosis of non-protruding gastric lesions,and may replace biopsy in real-time histological diagnosis.