结肠癌CT仿真内镜与电子结肠镜的对照研究

CT仿真内镜是利用工作站将螺旋 CT扫描得到的容积数据重建成类似电子结肠镜所见的图像,有关结肠 CT仿真内镜的文献多数是对结肠息肉及结肠癌检出率的报道 [1－ 3],结肠癌的 CT仿真内镜征象的报道较少 [4－ 6]。为探讨 CT仿真内镜在结肠癌检查中的应用价值,我们自 1998年 6月至 1999年 6月对 30例结肠癌进行了 CT仿真内镜检查与电子结肠镜的对照研究。现报告如下。 材料和方法 　　一、一般资料 收集 30例结肠癌病例的 CT仿真内镜及电子结肠镜材料,其中男 16例,女 14例;年龄 27～ 79岁,平均 59.2岁。病程 1个月～ 48个月,平均…     

虚拟现实技术在消化内镜培训中的应用与实践

消化内镜操作在消化系统疾病诊断和治疗中具有极其重要的作用。虚拟现实技术是一种可以创建和体验虚拟世界的计算机仿真系统,它利用计算机生成一种模拟环境,使用户沉浸到该环境中。虚拟现实消化内镜系统能帮助初学者较快掌握消化内镜诊疗操作的基本技能,使各级消化内镜培训中心的规范化教学成为可能。主要论述虚拟现实技术在消化内镜培训中的发展与应用。     

结肠镜教学培训模式的研究现状与进展

结肠镜作为早期诊断及介入治疗的主要手段,在结直肠癌的筛查和预防中起着关键作用。有效和全面的结肠镜培训是实现高质量结肠镜检查、降低结直肠癌发病率的重要因素。结肠镜医师的培训已不再局限于学徒模式,内镜仿真模拟器以及内镜技能评估工具的应用有效提高了培训质量。内镜带教医师再培训以及内镜教学培训新模式的建立同样为培养合格的内镜医师起到了有效的推动与促进作用。本文总结了目前国内外结肠镜教学培训模式及方法的研究现状与进展。     

内镜仿真模拟系统用于内镜医师初学者胃镜培训的研究

目的评价内镜仿真模拟系统用于内镜医师初学者胃镜培训的可行性。方法将胃镜初学者分为2组,A组4名学员,接受内镜仿真模拟系统培训,B组4名学员,接受传统的内镜培训。培训结束后,比较2组学员在最初10名查体者胃镜检查中的独立完成率、辅助完成率和不能完成率。结果2组在性别、年龄、学历以及工作年限上差异无统计学意义。模拟系统培训组的独立完成检查率以及辅助完成检查率显著高于传统组,而不能完成检查率明显低于传统组。结论内镜仿真模拟系统可用于胃镜培训,减少学习弯路,降低学习费用,值得推广。     

64层CT仿真内镜在冠状动脉检查中的应用价值初探

目的探讨64层CT仿真内镜在冠状动脉检查中的应用价值。方法回顾性分析20例患者的64层CT仿真内镜表现,与血管造影进行比较。结果280段血管优良显示251段;196段正常血管中184段表现为均匀环形结构、伪彩一致,4处误诊为软斑,8处误诊为钙化;6处软斑伪彩色上难以与管壁区分,但可见管壁变形;55处狭窄检出42处,示管腔不同程度丢失,检出率为76.36%,对≥50%狭窄与DSA诊断中度一致(kappa=0.693,P=0.001);3处闭塞,表现为盲端;3处溃疡,表面毛糙;钙化36处,呈肉柱状或圆顶状凸起、光照增强;支架3枚,光照明显增强。结论64层CT仿真内镜能显示冠状动脉内腔,结合其他成像有助于早期诊断。     

胶囊内镜和CT仿真内镜诊断小肠疾病的对照研究

目的评价胶囊内镜和cT仿真内镜（CTVE）在小肠病变诊断方面的临床应用价值。方法回顾性总结3l例临床怀疑小肠疾病行胶囊内镜和CTVE检查患者的临床资料,参照最终诊断结果（手术病例以病理诊断为金标准,非手术病例依据后续检查及随访结果给出最终诊断）统计胶囊内镜、CTVE以及二者联合的诊断阳性率并行对比分析。结果最终诊断阳性26例,包括小肠肿瘤性病变16例、非肿瘤性病变10例,阴性5例。胶囊内镜诊断阳性24例,包括小肠肿瘤性病变14例（其中2例定位不准确,7例不能定性）和非肿瘤性病变10例;CTVE诊断阳性17例,包括小肠肿瘤性病变14例（其中1例定位不准确,4例不能定性）和非肿瘤性病变3例;胶囊内镜联合CTVE诊断阳性26例,包括小肠肿瘤性病变16例、非肿瘤性病变10例。对于小肠肿瘤性病变,胶囊内镜和CTVE诊断阳性率相同,均为87．5％（14／16）;而在总体诊断阳性率方面,胶囊内镜为77．4％（24／31）,CTVE为54．8％（17／31）,胶囊内镜联合CT仿真内镜为83．9％（26／31）,二者联合总体诊断阳性率明显高于CTVE（P=0．004）,但与胶囊内镜比较差异无统计学意义（P〉0．05）,胶囊内镜与CTVE比较差异也无统计学意义（P=0．065）。结论胶囊内镜和CTVE均有助于小肠疾病的诊断,胶囊内镜在诊断小肠非肿瘤性病变方面更有优势,而CTVE在判断小肠肿瘤性病变的位置和结构方面优于胶囊内镜,二者联合使用可进一步提高检出小肠疾病的能力。     

仿真三维DSA血管内镜成像在颅内动脉狭窄诊治中的作用

目的：探讨仿真三维DSA血管内镜成像在颅内动脉狭窄诊治中的价值。方法回顾性分析76例颅内动脉狭窄患者的三维DSA血管内镜成像资料,其中11例患者行颅内动脉支架置入术,并应用三维血管内镜随访其支架置入后血管腔内情况。三维旋转数字图像由脑血管造影机球管和影像增强器的同步2次240。旋转获得,应用Volume Viewer软件对原始三维图像进行重建,固定密度值并选取感兴趣区,用Navigator软件进行三维血管内镜成像,观察血管腔内的结构情况。结果①76例患者三维DSA血管内镜成像清晰,共114处血管狭窄,内膜形态光滑87处,不光滑27处;斑块偏心81处,基本不偏心33处。②对11例患者行颅内动脉支架置入术,技术成功率100％,术后残余狭窄率均〈30％,预后良好。③三维DSA血管内镜随访支架置入的患者11例,术后6个月时7例患者的支架被内膜覆盖完全、光滑;术后12个月时10例患者的支架被内膜覆盖完全;术后18个月时1例患者的支架仍未被内膜完全覆盖。结论仿真三维DSA血管内镜成像是一种安全有效的评估颅内动脉管腔结构的方法,并可用于指导支架置入后抗血小板聚集药物的个体化治疗。     

内镜超声与仿真CT检查在胃癌分期诊断中的对比研究

目的评价内镜超声和仿真CT检查对胃癌患者术前分期的准确性。方法24例胃癌患者，术前行内镜超声及仿真CT检查，并与术后病理对照，以评价内镜超声与仿真CT检查在胃癌分期中的诊断价值。结果内镜超声对胃癌T、N、M分期的敏感性是：87．5％（21／24）；79.2％（19／24）；57．1％（4／7）。仿真CT对T、N、M分期的敏感性是：79．2％（19／24）；70．8％（17／24）；100.0％（7／7）。结论内镜超声检查对胃癌侵犯的深度和局部淋巴结转移的诊断有更为显著的诊断价值，仿真CT对于远处转移的判断是有利的补充手段。     

中国胶囊内镜临床应用指南

中华医学会消化内镜学分会胶囊内镜与小肠镜学组于2008年制订了《中华消化内镜学会胶囊内镜临床应用规范》,对我国规范使用胶囊内镜提供了有力参考。胶囊内镜检查经历10余年的发展,已经成为重要的消化道疾病检查手段,尤其是对小肠疾病的诊断。随着科学技术的不断进步,除了小肠胶囊内镜出现了部分改进之外,食管专用胶囊内镜、结肠专用胶囊内镜和专用磁控胶囊胃镜亦已进入临床应用阶段。所以,胶囊内镜与小肠镜学组决定与时俱进,更新和完善相关规范,在经过专家广泛讨论及多次修改后,现更新我国胶囊内镜临床应用指南如下。     

消化道疾病的内镜治疗进展

自从1957年Hirschowitz应用纤维内镜于临床以来,内镜已成为胃肠道疾病诊断的重要手段。新式光导纤维内镜的应用使内镜的功能从单纯诊断向治疗方面扩展。目前内镜治疗进展主要集中在以下领域。     

Virtual pancreatoscopy of pancreatic cancer

BACKGROUND/AIMS: Virtual endoscopy is a new method of diagnosis using computer processing of three-dimensional images data sets. However, there are few reports about the clinical application of virtual endoscopy for the pancreas. In this study, we evaluated the feasibility of surface-rendered magnetic resonance virtual endoscopy for pancreatic cancer. METHODOLOGY: Twenty-six cases of pancreatic cancer were studied. Fifteen patients had pancreatic head cancer, 7 had pancreatic body cancer, and 4 had pancreatic tail cancer. Twelve patients underwent surgical resection of the pancreas. Magnetic resonance imaging data were acquired with a 1.5-T clinical imager (Signal.5; GE Medical Systems, USA). We used a multislab single-shot fast spin-echo sequence. Section thickness was between 2 and 3 mm in the coronal plane. Three-dimensional reconstructed images and virtual endoscopic images were generated with Advantage Windows by GE. RESULTS: Virtual endoscopic images could be generated in 20 patients with pancreatic cancer (76.9%). In these cases, we were able to observe the inner surface of the pancreatic duct and the stricture from not only the pancreatic head but also the pancreatic tail. Clear virtual images could not be generated in 6 cases. We were able to divide the 20 cases in which images could be generated into groups according to the appearance of the stricture. The edge of the stricture appeared to be protruding in 4 cases (15.4%), and appeared to be polygonal in 13 cases (50.0%). In 3 cases, we recognized the existence of a stricture, but the detail of the stricture was unclear. CONCLUSIONS: Virtual endoscopy caused minimal discomfort compared to real endoscopic examination, and it can access cystic lesions and the pancreatic duct behind the stricture. It is concluded that virtual endoscopy for pancreatic cancer has potential clinical utility.     

Virtual gastroscopy: Initial attempt in North American patients

Background: Virtual endoscopy (VE) is a new evolving technology that describes the 3‐D reconstruction of medical image scans to create a visualization similar to that produced by fiber‐optic and video endoscopy. The present study was carried out to establish the feasibility of this technique in the upper gastrointestinal tract. Methods: Ten patients who underwent upper endoscopy for different clinical reasons and who were found to have a normal or near normal examination underwent a spiral computed tomography scan of the lower chest and abdomen. A 3‐D image was reconstructed using the Freeflight software. Results: The anatomy of the stomach including the lumen, the cardia, the pylorus, gastric folds and the incisura angularis were well‐visualized. It was not possible to visualize the esophagus by VE because the lumen was unable to be kept patent long enough to provide accurate imaging. Conclusions: The present preliminary study has demonstrated the feasibility of performing virtual gastroscopy. Further development in this area is needed before any routine clinical application.     

Virtual reality simulators for gastrointestinal endoscopy training

The use of simulators as educational tools for medical procedures is spreading rapidly and many efforts have been made for their implementation in gastrointestinal endoscopy training. Endoscopy simulation training has been suggested for ascertaining patient safety while positively influencing the trainees' learning curve. Virtual simulators are the most promising tool among all available types of simulators. These integrated modalities offer a human-like endoscopy experience by combining virtual images of the gastrointestinal tract and haptic realism with using a customized endoscope. From their first steps in the 1980s until today, research involving virtual endoscopic simulators can be divided in two categories: investigation of the impact of virtual simulator training in acquiring endoscopy skills and measuring competence. Emphasis should also be given to the financial impact of their implementation in endoscopy, including the cost of these state-of-theart simulators and the potential economic benefits from their usage. Advances in technology will contribute to the upgrade of existing models and the development of new ones; while further research should be carried out to discover new fields of application.     

Virtual reality simulators for gastrointestinal endoscopy training简

The use of simulators as educational tools for medical procedures is spreading rapidly and many efforts have been made for their implementation in gastrointestinal endoscopy training. Endoscopy simulation training has been suggested for ascertaining patient safety while positively influencing the trainees’ learning curve. Virtual simulators are the most promising tool among all available types of simulators. These integrated modalities offer a human-like endoscopy experience by combining virtual images of the gastrointestinal tract and haptic realism with using a customized endoscope. From their first steps in the 1980s until today, research involving virtual endoscopic simulators can be divided in two categories: investigation of the impact of virtual simulator training in acquiring endoscopy skills and measuring competence. Emphasis should also be given to the financial impact of their implementation in endoscopy, including the cost of these state-of-the-art simulators and the potential economic benefits from their usage. Advances in technology will contribute to the upgrade of existing models and the development of new ones; while further research should be carried out to discover new fields of application.     

CT仿真内镜对艾滋病合并支气管结核的临床应用价值

目的 探讨CT仿真内镜(computed tomography virtual endoscop,CTVE)对艾滋病合并支气管结核的临床应用价值.方法 收集2013年1月至2019年7月深圳市第三人民医院确诊为艾滋病且临床表现符合支气管结核的43例病例,行CT薄层连续容积扫描并用CT横断图像及CTVE图像对支气管病灶进...     

Confocal laser endomicroscopy in the ＂in vivo＂ histological diagnosis of the gastrointestinal tract

Recent technological advances in miniaturization have allowed for a confocal scanning microscope to be integrated into a conventional flexible endoscope, or into trans-endoscopic probes, a technique now known as confocal endomicroscopy or confocal laser endomicroscopy. This newly-developed technology has enabled endoscopists to collect real-time in vivo histological images or "virtual biopsies" of the gastrointestinal mucosa during endoscopy, and has stimulated significant interest in the application of this technique in clinical gastroenterology. This review aims to evaluate the current data on the technical aspects and the utility of this new technology in clinical gastroenterology and its potential impact in the future, particularly in the screening or surveillance of gastrointestinal neoplasia.     

Virtual endoscopy using multidetector-row CT for coil occlusion of patent ductus arteriosus.

The objective of this study was to report the clinical value of virtual endoscopy using multidetector-row CT (MDCT) for coil occlusion of patent ductus arteriosus (PDA). We studied 10 consecutive patients with PDA undergoing cardiac catheterization and coil occlusion. All patients had previously undergone MDCT, and subsequently underwent transcatheter closure of ductus. MDCT evaluations were performed again in 1-3 months after occlusion. Virtual endoscopy showed the anatomy of the orifice of the ductus and spatial relations of adjacent structures from both the aortic and pulmonary sides in all patients. We were able to observe the inner space, and fly through the PDA. This approach is the virtual view of the catheter advancing during coil occlusion. Following occlusion, visualization of the coil can also be established by viewing from inside. Coil protrusion into the aortic and pulmonary sides was clearly observed. Virtual endoscopy provides unique information regarding the ductal lumen that is of use for the coil occlusion of PDA.     

胶囊内镜临床应用规范研究与展望北大核心CSCD

胶囊内镜(capsule endoscopy,CE)因其使用方便、耐受性好、并发症少及对消化道的可视化程度高,是受患者普遍接受的胃肠道体检方案,已经成为了小肠内镜检查的一线检查方式。但是,胶囊内镜的临床应用仍需进一步规范。文章拟通过归纳美国胃肠内镜学会(ASGE)、欧洲胃肠内镜学会(ESGE)、中华消化内镜学会等多份指南对胶囊内镜操作、报告、培训的要求,总结胶囊内镜的规范化操作流程,归纳其在COVID-19流行背景下的应用情景,探讨胶囊内镜临床实践中所面临的问题,以及胶囊内镜教学未来可能的发展方向。     

Novel imaging modalities in the detection of oesophageal neoplasia

The prognosis of oesophageal neoplasia is dependent on the stage of the disease at the time of detection. Early lesions have an excellent prognosis in contrast to more advanced stages that usually have a dismal prognosis. Therefore, the early detection of these lesions is of the utmost importance. In recent years, several new techniques have been introduced to improve the endoscopic detection of early lesions. The most important improvement, in general, has been the introduction of high-resolution/high-definition endoscopy into daily clinical practice. The value of superimposing techniques such as chromoendoscopy, narrow band imaging and computed virtual chromoendoscopy onto high-resolution/high-definition endoscopy will have to be proven in randomised cross-over trials comparing these techniques with standard techniques. Important future adjuncts to white-light endoscopy serving as 'red-flag' techniques for the detection of early neoplasia may be broad field functional imaging techniques such as video autofluorescence endoscopy. In addition, real-time histopathology during endoscopy has become possible with endocytoscopy and confocal endomicroscopy. The clinical value of these techniques needs to be ascertained in the coming years.     

共聚焦激光显微内镜对早期上消化道肿瘤的诊断价值

上消化道肿瘤的早期诊断对改善患者的预后至关重要。共聚焦激光显微内镜是新近发展起来的新型内镜，可在常规内镜检查的同时获得放大1000倍的胃肠道表面和表面下的虚拟组织学图像。从而有可能提高诊断准确率。本文就共聚焦激光显微内镜在诊断早期上消化道肿瘤中的应用作一概述。