Pastorfide Gia, Fong Yoke Fai
Department of Obstetrics and Gynaecology, National University Hospital, Singapore.
Department of Obstetrics and Gynaecology, National University Hospital, Singapore.
J Minim Invasive Gynecol. 2015 May-Jun;22(4):535. doi: 10.1016/j.jmig.2015.01.002. Epub 2015 Jan 8.
To show a new technique using narrowband imaging for the detection of endometriosis.
A step-by-step illustration of the difference in visualization of endometriosis using a visible light spectrum laparoscope compared with a narrowband imaging light source.
Radical excision of endometriosis is considered the best treatment to control the disease extent and symptoms of endometriosis. Therefore, it is imperative that all endometriotic lesions are recognized and identified in order to thoroughly remove them. A narrowband imaging system enhances the visualization of capillary vessels and microstructures containing blood hemoglobin on the mucosal surface. It makes use of 415- and 540-nm filters that are strongly absorbed by blood hemoglobin. In this manner, microvessels, which are not clearly seen by conventional light, are enhanced. With the inherent neovascularization noted in endometriosis, endometriotic lesions may be more recognizable. Clear vesicular lesions of endometriosis are glandular excrescences, which are early signs of recurrent inflammation from endometriosis with accompanying angiogenesis. These are more pronounced under narrowband imaging.
The use of the visible light spectrum contrasted with narrowband imaging that changes the normal color contrasts of the endoscopic image in the different areas of the pelvic cavity.
Narrowband imaging is helpful as an additional modality for the identification of endometriosis. In particular, clear vesicular lesions of endometriosis, which are not as evident under the visible light spectrum, are more pronounced under narrowband imaging. Its strength lies in its usefulness in the treatment of patients with endometriosis with symptoms of pain. It is especially useful for those with marked symptoms but, on first glance at laparoscopy, seems to have minimal disease. Narrowband imaging enhances the endometriotic lesions and makes it easier to visualize and identify them, knowing that these subtle lesions may well be the cause of the pain. However, its usefulness is decreased if performed after the initiation of surgery because of the bleeding incurred from dissection, which makes it difficult to distinguish between the red blood cells and endometriotic lesions.
Narrowband imaging can be used as an adjunct to improve the detection of endometriosis.
展示一种使用窄带成像检测子宫内膜异位症的新技术。
逐步说明使用可见光光谱腹腔镜与窄带成像光源相比，在子宫内膜异位症可视化方面的差异。
根治性切除子宫内膜异位症被认为是控制疾病范围和子宫内膜异位症症状的最佳治疗方法。因此，必须识别并确定所有子宫内膜异位病变，以便彻底清除它们。窄带成像系统可增强粘膜表面毛细血管和含有血红蛋白的微观结构的可视化。它使用被血红蛋白强烈吸收的415纳米和540纳米滤光片。通过这种方式，传统光线下看不清楚的微血管得到增强。鉴于子宫内膜异位症中固有的新生血管形成，子宫内膜异位病变可能更易于识别。子宫内膜异位症的清晰水泡样病变是腺性赘生物，是子宫内膜异位症伴发血管生成的反复炎症的早期迹象。在窄带成像下这些表现更为明显。
将可见光光谱与窄带成像进行对比，窄带成像会改变盆腔不同区域内镜图像的正常颜色对比。
窄带成像作为识别子宫内膜异位症的辅助手段很有帮助。特别是，子宫内膜异位症的清晰水泡样病变在可见光光谱下不那么明显，而在窄带成像下更为明显。其优势在于对有疼痛症状的子宫内膜异位症患者的治疗有用。对于那些症状明显但在腹腔镜检查初看似乎疾病轻微的患者尤其有用。窄带成像可增强子宫内膜异位病变，使其更易于可视化和识别，因为知道这些细微病变很可能是疼痛的原因。然而，如果在手术开始后进行，其效用会降低，因为解剖会导致出血，这使得难以区分红细胞和子宫内膜异位病变。
窄带成像可作为一种辅助手段来提高子宫内膜异位症的检测率。
