摘要
目的探讨探头式共聚焦显微内镜(pCLE)辅助内科胸腔镜诊断胸膜疾病的应用价值,为胸膜早期病变的精准诊断提供参考。方法回顾2例不明原因胸腔积液且肿瘤标志物异常升高患者的诊疗过程。患者均先行常规内科胸腔镜检查,随后借助内科胸腔镜工作通道,通过pCLE对患者胸膜可疑部位开展实时在体组织学水平观察,最后对pCLE观察异常部位针对性进行胸膜组织细胞学检查及活检操作。结果2例患者经常规内科胸腔镜检查均未发现明显胸膜异常,未能明确活检取材部位;而pCLE检查均发现异型细胞团块,其中病例1术中胸水病理检查发现不典型腺上皮细胞团,病例2在pCLE指导下完成胸膜活检显示为恶性上皮性肿瘤,最终2例患者均经病理学检查确诊为肺腺癌。2例患者组织病理检查结果与pCLE术中观察结果高度契合。结论pCLE可实现胸膜在体组织学水平的实时观察,能有效识别胸膜早期微小病变,为内科胸腔镜下活检提供精准靶向指引,弥补常规内科胸腔镜的诊断缺陷,对提高胸膜早期疾病诊断率具有重要临床意义。
Objective To explore the clinical value of probe-based confocal laser endomicroscopy(pCLE)as an ad⁃junct to medical thoracoscopy in the diagnosis of pleural diseases,and to provide evidence for the precise diagnosis of early pleural lesions.Methods The diagnostic and therapeutic processes of two patients with pleural effusion of unknown etiol⁃ogy accompanied by abnormally elevated tumor markers were retrospectively analyzed.Both patients first underwent con⁃ventional medical thoracoscopy.Subsequently,pCLE was introduced through the working channel of the medical thoraco⁃scope to perform real-time,in vivo histological-level observation of suspicious pleural areas.Targeted pleural cytological examination and biopsy were then performed at sites showing abnormalities on pCLE.Results Conventional medical tho⁃racoscopy revealed no obvious pleural abnormalities in either patient,and appropriate biopsy sites could not be clearly identified.In contrast,pCLE detected clusters of atypical cells in both cases.In Case 1,intraoperative pleural effusion cy⁃tology revealed clusters of atypical glandular epithelial cells.In Case 2,pleural biopsy guided by pCLE demonstrated a ma⁃lignant epithelial tumor.Ultimately,both patients were pathologically confirmed to have lung adenocarcinoma.The histo⁃pathological findings were highly consistent with the intraoperative pCLE observations in both cases.Conclusions The pCLE enables real-time,in vivo histological-level visualization of the pleura and can effectively identify early,subtle pleu⁃ral lesions.It provides precise targeting guidance for pleural biopsy during medical thoracoscopy,compensates for the diag⁃nostic limitations of conventional medical thoracoscopy,and has important clinical value in improving the diagnostic rate of early pleural diseases.
作者
叶胜兰
朱珊
袁明丽
宋成
胡轶
倪吉祥
YE Shenglan;ZHU Shan;YUAN Mingli;SONG Cheng;HU Yi;NI Jixiang(Department of Respiratory and Critical Care Medicine,Wuhan Central Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430015,China)
出处
《山东医药》
2026年第1期100-103,共4页
Shandong Medical Journal
基金
湖北省武汉市自然科学基金探索计划(晨光计划)市属医疗机构临床研究重点专项项目(2025020701020249)。
关键词
探头式共聚焦显微内镜
内科胸腔镜
早期胸膜病变
不明原因胸腔积液
肺腺癌
probe-based confocal laser endomicroscopy
medical thoracoscopy
early pleural lesions
unexplained pleural effusion
lung adenocarcinoma
