国产探头式共聚焦显微内镜在胆管狭窄中的临床应用

Clinical application of a domestically produced probe‑based confocal laser endomicroscopy for biliary stricture

摘要:

目的 评估首款国产探头式共聚焦显微内镜（probe‑base confocal laser endomicroscopy，pCLE）对良恶性胆管狭窄的成像效果及临床操作性。方法 纳入2023年1月至2024年12月于武汉大学中南医院就诊的31例胆管狭窄患者。使用国产pCLE结合迈阿密分级和巴黎分级对胆管狭窄进行影像学诊断。以细胞刷检或活组织病理检查结果为胆管狭窄良恶性的金标准，记录良性和恶性胆管狭窄pCLE下特征。结果 在pCLE镜下，正常胆管主要表现为浅灰色背景下的细而均匀的网状暗带，血管轻微扩张有荧光素钠渗出，形态规则。18例炎性狭窄pCLE下可见网状暗带增粗，可见扩张充血的血管，以及显著荧光素钠渗出等炎性改变。13例恶性狭窄pCLE下可见明显增宽的宽暗带或者稍粗亮的宽亮带，血管扭曲不规则，可见岛状分布的黑色细胞团块及上皮结构改变等恶性特征。结论 宽暗带、宽亮带、黑色细胞团块、扭曲不规则的血管和坏死的上皮结构是国产pCLE下胆管恶性狭窄的主要特征，有助于胆管狭窄良恶性的鉴别。

Abstract:

Objective To evaluate the imaging effects and clinical feasibility of a domestically-produced probe-based confocal laser endomicroscopy (pCLE) for differentiating benign and malignant biliary stricture. Methods Thirty-one patients with biliary stricture were enrolled at Zhongnan Hospital of Wuhan University from January 2023 to December 2024. The domestically developed pCLE system was used for imaging diagnosis for biliary stricture, based on the Miami and Paris classifications. Cytological or histopathological findings served as the gold standard, pCLE characteristics of benign and malignant biliary stricture were recorded. Results Under pCLE, normal bile ducts exhibited fine and uniform reticular dark bands against a light gray background, with mildly dilated vessels and slight fluorescein leakage, presenting a regular morphology. In 18 cases of inflammatory stricture, pCLE revealed thickened reticular dark bands, dilated and congested vessels, and significant fluorescein leakage. In 13 cases of malignant stricture, pCLE demonstrated markedly widened dark bands or coarse bright bands, tortuous and irregular vessels, island-like clusters of dark cellular masses, and epithelial architectural distortion. Conclusion The domestic pCLE system effectively identifies malignant features—including widened dark/bright bands, dark cellular clusters, twisted and irregular vessels, and epithelial necrosis—facilitating differential diagnosis of biliary strictures.