Goetz M, Kiesslich R, Dienes H-P, Drebber U, Murr E, Hoffman A, Kanzler S, Galle P R, Delaney P, Neurath M F
First Medical Clinic, University of Mainz, Mainz, Germany.
Endoscopy. 2008 Jul;40(7):554-62. doi: 10.1055/s-2008-1077296.
Confocal endomicroscopy is a unique novel tool for in vivo histology in humans. Due to limitations imposed by the form of the equipment and by sterilization workflows, its use has been limited to the gastrointestinal tract so far. We have developed a rigid miniaturized probe for confocal endomicroscopy of the human liver during laparoscopy.
To assess the feasibility and potential clinical value of this new system (diameter 6.3 mm), 25 patients with liver disease were examined during routine minilaparoscopy under conscious sedation.
Subsurface serial images (from surface to 250 microm) were generated in real time after fluorescein injection, permitting visualization of hepatocytes, bile ducts, sinusoids, and collagen fibers in vivo. Typical appearances of liver diseases were identified. Confocal diagnosis of moderate-to-severe steatosis and pericellular fibrosis correlated well with histopathologic analysis of subsequent biopsies (83.3 % and 84.6 %, respectively). In addition, intra-abdominal structures such as gallbladder, omentum, and stomach were analyzed by endomicroscopy.
A miniaturized imaging system for confocal laparoscopy allowed in vivo microscopic analysis of healthy and diseased human liver for the first time during ongoing minilaparoscopy. Although such in vivo imaging does not yet compete with conventional histopathology, this novel confocal laparoscopy system may be of future relevance for immediate morphodynamic analysis in liver disease and the targeting of biopsies in vivo.
共聚焦内镜显微镜是一种用于人体活体组织学检查的独特新型工具。由于设备形式和消毒流程的限制，其应用目前仅限于胃肠道。我们开发了一种用于腹腔镜检查时对人体肝脏进行共聚焦内镜显微镜检查的刚性微型探头。
为评估这个新系统（直径6.3毫米）的可行性和潜在临床价值，在清醒镇静下对25例肝病患者进行了常规微型腹腔镜检查。
注射荧光素后实时生成了从表面到250微米的亚表面序列图像，可在体内观察肝细胞、胆管、肝血窦和胶原纤维。识别出了典型的肝病表现。共聚焦诊断中重度脂肪变性和细胞周围纤维化与后续活检的组织病理学分析相关性良好（分别为83.3%和84.6%）。此外，还通过内镜显微镜对胆囊、网膜和胃等腹腔内结构进行了分析。
一种用于共聚焦腹腔镜检查的微型成像系统首次在进行中的微型腹腔镜检查期间实现了对健康和患病人体肝脏的体内微观分析。尽管这种体内成像尚无法与传统组织病理学相媲美，但这种新型共聚焦腹腔镜检查系统可能对肝病的即时形态动力学分析和体内活检靶向具有未来意义。
