消化道早癌的诊断3.pptx

消化道早癌的内镜诊断;概 述;发现早癌的内镜诊断技术;白光内镜发现早癌的前提;一、染色内镜;;;Indigo carmine;;二、特殊光谱及放大内镜;;EP, epithelium; LPM, lamina propria mucosae; MM, muscularis mucosae; SM, submucosa; PM, proper muscle; M1, cancer is limited epithelium; M2, cancer invades LPM but does not reach MM; M3, cancer invasion reaches MM; SM, submucosally invasive cancer;NBI imaging of a lesion of IPCL type III. ;This pattern is called IPCL-V1. IPCL-V1 includes four major characteristic morphological changes of IPCL: dilation, meandering, irregular caliber, and figure variation. T1a.;This is typical image of intrapapillary capillary loop (IPCL)-V3. Cancer invasion depth was M3 (muscularis mucosae: T1a).;Large white arrows point to large tumor vessel (IPCL-VN). The striking morphological feature is its extra-large diameter. Note the difference of vessel caliber between IPCL-V3 (small white arrow) and VN (large white arrow: T1b or deeper). ;;MNBI, magnifying endoscopy with narrow-band imaging; LBC, light blue crest;;C-WLI: 轻微凹陷。 M-NBI：irregular MV and MS with a clear demarcation line. Histopathological findings: a well-differentiated adenocarcinoma confined to the mucosa;Pit pattern classification (1);血管袢(CP，sano)分型(佐野分型);Modified 3-step strategy of NBI colonoscopy.;(a) 普通光下观察，乙状结肠息肉，0.4cm，表面无明显平坦变化 (b) NBI：NBI放大下见明显凹陷，pit pattern为IIIB（佐野分型）提示有黏膜下侵犯，肉眼观呈“0-I s + II c”,这种病变易出现黏膜下侵犯。 (c)结晶紫染色：呈VN?pits，为浸润性改变，强烈提示深度黏膜下层侵犯。外科手术。 (d)病理发现：中分化腺癌. ;;图 1. 现有结直肠息肉的 NICE 分类;Typical endoscopic findings of NICE classification;;三、其它内镜检查;EUS：20MHz;Confocal Endomicroscopy in normal colonic epithelium;五、内镜下活检;我科胃癌的早期筛查流程; ;;V??n?nen. Eur J Gastroenterol Hepatol 2003 ;;谢 谢