高分辨率显微内镜对消化道正常黏膜的成像研究*

High resolution micro-endoscopy for digestive tract normal mucosa*

摘要:

目的 总结消化道正常黏膜的高分辨率显微内镜（HRME）的图片特点。方法 选择正常食道黏膜、胃黏膜、十二指肠黏膜、小肠黏膜和结肠黏膜活检标本各10例为研究对象，利用HRME分别对其进行成像观察，根据采集的HRME图片对不同部位的消化道正常黏膜进行描述性分析，总结其HRME图片特点。成像结束后所有标本常规行病理检查。结果 50例活检标本共获得1 284张HRME图片，经筛查后，留取400张图片用于结果分析。不同部位消化道正常黏膜的HRME图片特点如下：①食道黏膜：细胞排列规则，细胞核圆而亮，大小一致，核间距正常，每个视野里细胞的数量基本一致；②胃底黏膜：浅层可见腺体排列规则，呈分枝状。胃小凹开口呈圆形或类椭圆形，周边裂隙呈线样，细胞核排列规则；③胃窦黏膜：浅层可见胃小凹开口呈不规则形或管状，腺腔呈裂隙状，小凹周围细胞排列规则，细胞核小且分布密集；④十二指肠黏膜：可见绒毛呈宽大的指状，绒毛两侧有锯齿状凹陷，立体感明显，呈簇状排列，间隙呈裂隙状；⑤小肠黏膜：绒毛状结构较宽，间隙较宽大，数量较十二指肠少；⑥结肠黏膜：细胞核大小一致、形态规则，为圆形或椭圆形以及菊花状的腺体结构。所有标本病理结果均证实为正常黏膜。结论 HRME可以准确地辨别不同部位消化道正常黏膜，与病理结果比较，具有很高的一致性。

Abstract:

Objective To summarize the picture features of high resolution micro-endoscopy (HRME) for normal gastrointestinal mucosa. Methods We select 10 cases' normal esophageal mucosa, gastric and duodenal mucosa, intestinal mucosa and colonic mucosal biopsies for this study, use HRME to observe the specimens and describe the features of different parts of the digestive tract normal mucosa according to the collected HRME pictures. Results After HRME imaging, all specimens were sent to pathological examination. We obtained 1 284 HRME pictures for 50 cases of biopsy specimens, 400 pictures were selected for results analysis after screening. HRME image characteristics of different parts of the digestive tract normal mucosa are as follows. Esophageal mucosa: cell arrangement rules, round and bright nucleus, the same size, nuclear spacing normal, the number of cells per field in basically are the same. Fundic mucosa: numerous closely arranged glands as well as oval or elongated branched openings of the gastric pits and linear peripheral cracks were visible; the nuclei were arranged regularly. Antral mucosa: irregular or tubular openings of the gastric pits and cracked glandular cavities were visible, with the cells surrounding the gastric pits regularly arranged and the nuclei small and densely distributed. Duodenal mucosa: visible villi was large fingers, on both sides of lint jagged depression, stereoscopic obviously, a cluster-like arrangement and the gap was crack-like. Intestinal mucosa: villous structures wider gap is wider, less than the number of the duodenum. Colonic mucosa: the nucleus of the same size, shape rules, round or oval and daisy-like glandular structures. All specimens were confirmed normal mucosa by pathology. Conclusion HRME can accurately identify the different parts of the digestive tract normal mucosa and it has a high consistency compared with pathological results.