刘涛?姚嘉茵?江紫莹?郅敏

【摘要】目的 探讨共聚焦激光内镜（CLE）预测结肠息肉组织病理学结果的可行性。方法 对纳入的结肠息肉，由一位经验丰富的内镜医师独立完成CLE检查，并完成对息肉性质、腺瘤性息肉组织学分型及分级的诊断，1个月后该医师及另一位初学者重新根据图像分别进行组织病理学诊断，以验证一致性。结果 共纳入41例结肠息肉患者（64枚息肉），其中腺瘤性息肉41枚，非腺瘤性息肉23枚。CLE诊断腺瘤性息肉的灵敏度97.6%、特异度82.6%，同一医师前后及不同医师间的结果均高度一致（Kappa值分别为0.838和0.889）。CLE对腺瘤息肉组织学分型的准确性为90.2%，初学者相对较低为80.5%。将腺体形态、血管形态、腺上皮形态及细胞形态按严重程度分为1 ～ 3级，分析发现高级别上皮内瘤变组分级均高于低级别上皮内瘤变组（P < 0.05）。结论 CLE不仅可以鉴别结肠息肉的性质，还可以对腺瘤性息肉进行组织学分型，同时也具有对腺瘤性息肉进行组织学分级的潜在价值。

【关键词】共聚焦激光内镜;结肠息肉;进展期腺瘤

Confocal laser endoscopy for the diagnosis of colonic polyps LiuTao， Yao Jiayin， Jiang Ziying， Zhi Min.Department of Gastroenterology， the Sixth Affiliated Hospital of Sun Yat-sen University， Guangzhou 510655， China

Corresponding author， Zhi Min， E-mail： zhimin@mail. sysu.edu.cn

【Abstract】Objective To explore the feasibility of confocal laser endoscopy（CLE） for predicting the histopathological outcomes of colonic polyps. Methods CLE was independently performed by an experienced endoscopist to make the diagnosis of polyps nature and histological classification and grading of adenomatous polyps. One month later， histopathological diagnosis was made again according to the CLE images by the same endoscopist and another beginner to validate the agreement between twice diagnoses. Results A total of 41 patients （64 polyps） were enrolled including 41 adenomatous polyps and 23 non-adenomatous polyps. The sensitivity and specificity of CLE for the diagnosis of adenomatous polyps were 97.6% and 82.6%， respectively. The intra-observer and inter-observer agreements were high （Kappa = 0.838 and 0.889， respectively）. The accuracy of CLE for predicting histological classification of adenomatous polyps was 90.2%， and 80.5% for the beginner. The morphology of gland， blood vessel， glandular epithelium and cells was classified into grade 1-3 according to the severity. The score of high-grade intraepithelial neoplasia was significantly higher than that of low-grade intraepithelial neoplasia （P < 0.05）. Conclusions CLE can not only differentiate the nature of colonic polyps， but also predict the histological classification of adenomatous polyps. Besides， it also has potential in evaluating the histological grading of adenomatous polyps.

【Key words】Confocal laser endoscopy;Colonic polyps;Progressive adenoma

2018年全球新發结直肠癌约为180万，但由于大部分患者确诊时处于进展期，仍约有90万死亡病例[1]。研究显示，内镜下切除腺瘤性息肉可使结直肠癌相关病死率明显下降[2]。然而超过90%的大肠息肉是小息肉或微小息肉，其中微小息肉仅1.7%伴有进展期组织学特征，如绒毛状结构或高级别上皮内瘤变（HGIN） [3-5]。息肉切除目前仍然是导致结肠镜检查并发症的主要原因之一[6]。鉴于此，是否需切除所有息肉，尤其是非肿瘤性小息肉及微小息肉仍未达成一致。近年来“诊断-遗留”和“切除-丢弃”2个策略逐渐兴起以解决上述问题，但受限于在体诊断的准确性，目前这2项策略也仅针对微小息肉，且仍尚未完全实现[7-8]。……