共聚焦內(nèi)鏡的學(xué)習(xí)與培訓(xùn)課件

1、共聚焦顯微內(nèi)鏡的學(xué)習(xí)與培訓(xùn)Learning and Training of Confocal Endomicroscopy 提 綱 學(xué)習(xí)與培訓(xùn)的實(shí)施要點(diǎn) 共聚焦內(nèi)鏡學(xué)習(xí)曲線 The Learning Pyramid The Training Ethos Tell me and I forget Show me and I remember Involve me and I learn -Benjamin Franklin 怎樣學(xué)習(xí)效果最好Adults learn best when:They are motivatedThe learning is relevantThe aims and o

2、bjectives are clearThey are actively involvedA variety of learning methods is usedThey get feedbackIt is FUN!“The ability to establish an immediate endoscopic diagnosis that is virtually consistent with the histologic diagnosis has been the ultimate objective of endoscopists since the very earliest

3、phases of the development of endoscopy.”Kudo, Gastrointest Endosc 1996 共聚焦激光顯微內(nèi)鏡是一種革命 共聚焦激光顯微內(nèi)鏡是一種趨勢(shì) 兩種共聚焦內(nèi)鏡比較eCLEpCLE優(yōu)勢(shì)獲得的圖片可以在不同組織層面圖片掃描速度更快在臨床操作中更靈活可以獲得動(dòng)態(tài)圖像，觀察血流缺點(diǎn)花費(fèi)較高需要利用對(duì)比劑 兩種主要的造影劑熒光素鈉(靜脈使用，顯示組織結(jié)構(gòu)) 用于視網(wǎng)膜血管造影的靜脈注射吖啶黃 (通過(guò)鉗道使用噴管進(jìn)行，顯示細(xì)胞核）熒光素鈉染色 吖啶黃染色 怎樣學(xué)習(xí)共聚焦內(nèi)鏡？圖片識(shí)別操作過(guò)程 識(shí)圖面臨的困惑?是否需要掌握足夠多的病理知識(shí)呢?是否很難

4、掌握呢？請(qǐng)跟隨以下的幾篇共聚焦內(nèi)鏡學(xué)習(xí)曲線研究一起來(lái)認(rèn)識(shí)共聚焦圖片以及了解共聚焦學(xué)習(xí)的難易程度。食管胃結(jié)腸BE食管 食管上皮內(nèi)瘤變胃上皮內(nèi)瘤變胃息肉IBD結(jié)腸上皮內(nèi)瘤變食管病變16 食 管 Barrett食管正常食管粘膜: 鱗狀上皮Z-線: 食管鱗柱狀上皮交界處 熒光造影劑：熒光素鈉 (5ml；10%)Barrett食管鱗狀上皮柱狀上皮Gaddam S, Mathur SC, Singh M et al. Novel probe-based confocal laser endomicroscopy criteria and interobserver agreement for the de

5、tection of dysplasia in Barretts esophagus. Am J Gastroenterol 2011; 106: 1961-196922Gaddam S, Mathur SC, Singh M et al. Novel probe-based confocal laser endomicroscopy criteria and interobserver agreement for the detection of dysplasia in Barretts esophagus. Am J Gastroenterol 2011; 106: 1961-1969G

6、addam S, Mathur SC, Singh M et al. Novel probe-based confocal laser endomicroscopy criteria and interobserver agreement for the detection of dysplasia in Barretts esophagus. Am J Gastroenterol 2011; 106: 1961-1969 結(jié) 果1.有經(jīng)驗(yàn)組與無(wú)經(jīng)驗(yàn)組診斷準(zhǔn)確率無(wú)統(tǒng)計(jì)學(xué)差異2.前30組錄像與后45 組錄像的診斷準(zhǔn)確率無(wú)統(tǒng)計(jì)學(xué)差異共聚焦內(nèi)鏡圖片診斷Barrett 食管學(xué)習(xí)曲線較短操作過(guò)程Kerr

7、y B.Dunbar, Elizabeth A. Montgomery, Marcia I,Canto et al. The learning curve of in vivo Confocal Laser Endomicroscopy for prediction of Barretts Esophagus Abstract19 GERD without known BE 58 BE surveillance 41 Possible BE-associated neoplasiaWith prior hands on experience of 30 supervised cases 操作過(guò)

8、程Kerry B.Dunbar, Elizabeth A. Montgomery, Marcia I,Canto et al. The learning curve of in vivo Confocal Laser Endomicroscopy for prediction of Barretts Esophagus Abstract一個(gè)無(wú)經(jīng)驗(yàn)內(nèi)鏡醫(yī)師大約經(jīng)過(guò)100例的共聚焦內(nèi)鏡操作學(xué)習(xí)過(guò)程就可以掌握共聚焦內(nèi)鏡對(duì)BE食管的實(shí)時(shí)診斷 食管上皮內(nèi)瘤變及食管癌SMS 評(píng)分法Li M, Zuo XL, Yu T, et al. Surface maturation scoring for oesop

9、hageal squamous intraepithelial neoplasia: a novel diagnostic approach inspired by first endomicroscopic 3-dimensional reconstruction. Gut. 2012 早期食管癌Study in our center 食管炎癥Study in our center由學(xué)前培訓(xùn) 約0.5h 共聚焦及食管病理知識(shí)表面成熟評(píng)分法5張良性，5張瘤變Learning curve and inter-observer agreement of confocal laser endomic

10、roscopy for the detection of precancerous or early stage esophageal squamous cancers Study in our center 觀察者診斷的準(zhǔn)確性Study in our center 無(wú)經(jīng)驗(yàn)組學(xué)習(xí)曲線評(píng)估Study in our center 診斷時(shí)間Study in our center胃（上皮內(nèi)瘤變及息肉）35 正常胃粘膜組織胃體胃竇熒光造影劑：熒光素鈉 (5ml; 10%)陷凹開(kāi)口柱狀上皮郭玉婷、李延青等，中華消化內(nèi)鏡雜志，2007Lim LG, Yeoh KG, Salto-Tellez M et al

11、. Experienced versus inexperienced confocal endoscopists in the diagnosis of gastric adenocarcinoma and intestinal metaplasia on confocal images. Gastrointest Endosc 2011; 73: 1141-1147Lim LG, Yeoh KG, Salto-Tellez M et al. Experienced versus inexperienced confocal endoscopists in the diagnosis of g

12、astric adenocarcinoma and intestinal metaplasia on confocal images. Gastrointest Endosc 2011; 73: 1141-1147Lim LG, Yeoh KG, Salto-Tellez M et al. Experienced versus inexperienced confocal endoscopists in the diagnosis of gastric adenocarcinoma and intestinal metaplasia on confocal images. Gastrointe

13、st Endosc 2011; 73: 1141-1147Lim LG, Yeoh KG, Salto-Tellez M et al. Experienced versus inexperienced confocal endoscopists in the diagnosis of gastric adenocarcinoma and intestinal metaplasia on confocal images. Gastrointest Endosc 2011; 73: 1141-114740 胃（上皮內(nèi)瘤變及腺癌）Pittayanon R, Rerknimitr R, Wisedop

14、as N et al. The learning curve of gastric intestinal metaplasia interpretation on the images obtained by probe-based confocal laser endomicroscopy. Diagn Ther Endosc 2012; 2012: 27804541 胃上皮內(nèi)瘤變及腺癌Pittayanon R, Rerknimitr R, Wisedopas N et al. The learning curve of gastric intestinal metaplasia inter

15、pretation on the images obtained by probe-based confocal laser endomicroscopy. Diagn Ther Endosc 2012; 2012: 2780451h 培訓(xùn)，5段GIM pcle錄像,5段非GIM pcle錄像20 videos20 videos20 videos20 videos42Pittayanon R, Rerknimitr R, Wisedopas N et al. The learning curve of gastric intestinal metaplasia interpretation o

16、n the images obtained by probe-based confocal laser endomicroscopy. Diagn Ther Endosc 2012; 2012: 278045 胃上皮內(nèi)瘤變及腺癌43 共聚焦顯微內(nèi)鏡下胃息肉診斷學(xué)習(xí)曲線研究共聚焦顯微內(nèi)鏡診斷胃息肉和腺瘤QILU標(biāo)準(zhǔn) 增生性息肉 胃腺瘤 增生上皮細(xì)胞圍繞 異常的腺細(xì)胞較細(xì)長(zhǎng)，熒光較暗，間質(zhì)細(xì)胞特點(diǎn) 隱窩排列，細(xì)胞核的 熒光較亮（熒光素鈉），異形腺上皮排列 大小形態(tài)正常， 不規(guī)則，呈嵴狀或絨毛狀，細(xì)胞核大小形態(tài) 位于細(xì)胞基底部。 不規(guī)則（吖啶黃） 隱窩上皮顯著增生 隱窩細(xì)胞呈現(xiàn)嵴狀或絨毛或腦回狀排列

17、隱窩結(jié)構(gòu) 可見(jiàn)規(guī)則伸長(zhǎng)擴(kuò)張 形狀不一致，在不同層面可見(jiàn)擴(kuò)張、彎曲 隱窩，間質(zhì)熒光素 大小不一的腺體開(kāi)口 鈉滲出及炎細(xì)胞浸潤(rùn) Study in our center 增生性息肉（熒光素鈉）增生性胃息肉（吖啶黃）Study in our center 胃腺瘤（熒光素鈉） 胃腺瘤（吖啶黃） Study in our center材料和方法學(xué)前訓(xùn)練講明研究目的及共聚焦常識(shí)胃息肉齊魯標(biāo)準(zhǔn)學(xué)習(xí)典型15處病變學(xué)習(xí)123Study in our center材料和方法 病變性質(zhì) 讀取時(shí)間 公布結(jié)果 公布結(jié)果 公布結(jié)果 間隔1周 間隔1周 間隔1周第1階段第2階段第3階段第4階段80個(gè)獨(dú)立文件夾（隨機(jī)分為4個(gè)部

18、分，每個(gè)階段包含20個(gè))學(xué)習(xí)過(guò)程Study in our center共聚焦顯微內(nèi)鏡下初學(xué)者及有經(jīng)驗(yàn)者各個(gè)學(xué)習(xí)階段對(duì)胃息肉診斷的準(zhǔn)確率Study in our centerIBD IBDNeumann H, Vieth M, Atreya R et al. Prospective evaluation of the learning curve of confocal laser endomicroscopy in patients with IBD. Histol Histopathol 2011; 26: 867-872 IBDNeumann H, Vieth M, Atreya R et

19、 al. Prospective evaluation of the learning curve of confocal laser endomicroscopy in patients with IBD. Histol Histopathol 2011; 26: 867-872 IBDNeumann H, Vieth M, Atreya R et al. Prospective evaluation of the learning curve of confocal laser endomicroscopy in patients with IBD. Histol Histopathol

20、2011; 26: 867-872He attended a workshop on CLE before the studyCellvizio14 UC12 CDNeumann H, Vieth M, Atreya R et al. Prospective evaluation of the learning curve of confocal laser endomicroscopy in patients with IBD. Histol Histopathol 2011; 26: 867-872Neumann H, Vieth M, Atreya R et al. Prospectiv

21、e evaluation of the learning curve of confocal laser endomicroscopy in patients with IBD. Histol Histopathol 2011; 26: 867-872Neumann H, Vieth M, Atreya R et al. Prospective evaluation of the learning curve of confocal laser endomicroscopy in patients with IBD. Histol Histopathol 2011; 26: 867-872結(jié)腸

22、上皮內(nèi)瘤變Kuiper T, Kiesslich R, Ponsioen C et al. The learning curve, accuracy, and interobserver agreement of endoscope-based confocal laser endomicroscopy for the differentiation of colorectal lesions. Gastrointest Endosc 2012; 75: 1211-1217正常粘膜Kuiper T, Kiesslich R, Ponsioen C et al. The learning cur

23、ve, accuracy, and interobserver agreement of endoscope-based confocal laser endomicroscopy for the differentiation of colorectal lesions. Gastrointest Endosc 2012; 75: 1211-1217增生性息肉Kuiper T, Kiesslich R, Ponsioen C et al. The learning curve, accuracy, and interobserver agreement of endoscope-based

24、confocal laser endomicroscopy for the differentiation of colorectal lesions. Gastrointest Endosc 2012; 75: 1211-1217管狀腺瘤對(duì)Mains標(biāo)準(zhǔn)的詳細(xì)講解，以及10張共聚焦圖片示例30張圖片30張圖片30張圖片6 個(gè)月后將圖片重新排列，進(jìn)行相同的過(guò)程 結(jié) 果三位內(nèi)鏡醫(yī)師對(duì)3組共聚焦圖片均具有較高的診斷準(zhǔn)確率Buchner AM, Gomez V, Heckman MG et al. The learning curve of in vivo probe-based confocal laser endomicroscopy for prediction of colorectal neoplasia. Gastrointest Endosc 2011; 73: 556-560Comparing the learning curve of different studies of CLE in the GI tract.Gaddam et al. AmJ Gastroenterol2011Pittayanon R et al. Diagn Ther Endosc 2012Kuiper et al.GastrointestEndosc 201