Crowe Christopher S, Liao Joseph C, Curtin Catherine M
Division of Plastic and Reconstructive Surgery, Stanford School of Medicine, Stanford, CA, USA.
Division of Urology, Stanford School of Medicine, Stanford, CA, USA.
Arch Plast Surg. 2015 Sep;42(5):626-9. doi: 10.5999/aps.2015.42.5.626. Epub 2015 Sep 15.
Peripheral nerve injuries remain a challenge for reconstructive surgeons with many patients obtaining suboptimal results. Understanding the level of injury is imperative for successful repair. Current methods for distinguishing healthy from damaged nerve are time consuming and possess limited efficacy. Confocal laser endomicroscopy (CLE) is an emerging optical biopsy technology that enables dynamic, high resolution, sub-surface imaging of live tissue. Porcine sciatic nerve was either left undamaged or briefly clamped to simulate injury. Diluted fluorescein was applied topically to the nerve. CLE imaging was performed by direct contact of the probe with nerve tissue. Images representative of both damaged and undamaged nerve fibers were collected and compared to routine H&E histology. Optical biopsy of undamaged nerve revealed bands of longitudinal nerve fibers, distinct from surrounding adipose and connective tissue. When damaged, these bands appear truncated and terminate in blebs of opacity. H&E staining revealed similar features in damaged nerve fibers. These results prompt development of a protocol for imaging peripheral nerves intraoperatively. To this end, improving surgeons' ability to understand the level of injury through real-time imaging will allow for faster and more informed operative decisions than the current standard permits.
周围神经损伤对于重建外科医生来说仍然是一项挑战，许多患者的治疗效果并不理想。了解损伤程度对于成功修复至关重要。目前区分健康神经和受损神经的方法既耗时又效果有限。共聚焦激光内镜显微镜检查（CLE）是一种新兴的光学活检技术，能够对活组织进行动态、高分辨率的表面下成像。猪坐骨神经要么保持未受损状态，要么短暂夹闭以模拟损伤。将稀释的荧光素局部应用于神经。通过将探头直接接触神经组织进行CLE成像。收集代表受损和未受损神经纤维的图像，并与常规苏木精-伊红（H&E）组织学进行比较。未受损神经的光学活检显示出纵向神经纤维束，与周围的脂肪和结缔组织不同。受损时，这些纤维束会出现截断，并终止于不透明的小泡。H&E染色在受损神经纤维中显示出类似特征。这些结果促使制定术中对周围神经进行成像的方案。为此，与当前标准相比，通过实时成像提高外科医生了解损伤程度的能力将有助于做出更快、更明智的手术决策。
