共聚焦內(nèi)鏡的學(xué)習(xí)與培訓(xùn)課件

共聚焦顯微內(nèi)鏡的學(xué)習(xí)與培訓(xùn)

LearningandTrainingofConfocalEndomicroscopy齊魯醫(yī)院消化科左秀麗共聚焦顯微內(nèi)鏡的學(xué)習(xí)與培訓(xùn)

LearningandTra1

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)曲線提綱2

TheLearningPyramidTheLearningPyramid3

The

TrainingEthos?TellmeandIforget?ShowmeandIremember?InvolvemeandIlearn--BenjaminFranklinTheTrainingEthos4

怎樣學(xué)習(xí)效果最好Adultslearnbestwhen:TheyaremotivatedThelearningisrelevantTheaimsandobjectivesareclearTheyareactivelyinvolvedAvarietyoflearningmethodsisusedTheygetfeedbackItisFUN!怎樣學(xué)習(xí)效果最好5“Theabilitytoestablishanimmediateendoscopicdiagnosisthatisvirtuallyconsistentwiththehistologicdiagnosishasbeentheultimateobjectiveofendoscopistssincetheveryearliestphasesofthedevelopmentofendoscopy.”Kudo,GastrointestEndosc1996

共聚焦激光顯微內(nèi)鏡是一種革命“Theabilitytoestablishani6

共聚焦激光顯微內(nèi)鏡是一種趨勢共聚焦激光顯微內(nèi)7

兩種共聚焦內(nèi)鏡比較兩種共聚焦內(nèi)鏡比較8

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

(通過鉗道使用噴管進(jìn)行，顯示細(xì)胞核）兩種主要的造影劑熒光素鈉9熒光素鈉染色熒光素鈉染色10

吖啶黃染色吖啶黃染色11

怎樣學(xué)習(xí)共聚焦內(nèi)鏡？圖片識別操作過程怎樣學(xué)習(xí)共聚焦內(nèi)鏡？圖片識別操作過程12

識圖面臨的困惑?是否需要掌握足夠多的病理知識呢?是否很難掌握呢？請跟隨以下的幾篇共聚焦內(nèi)鏡學(xué)習(xí)曲線研究一起來認(rèn)識共聚焦圖片以及了解共聚焦學(xué)習(xí)的難易程度。識圖面臨的困惑?是否需要掌握足夠多的病13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)14食管病變食管病變15

食

管16食管16共聚焦內(nèi)鏡的學(xué)習(xí)與培訓(xùn)課件17共聚焦內(nèi)鏡的學(xué)習(xí)與培訓(xùn)課件18共聚焦內(nèi)鏡的學(xué)習(xí)與培訓(xùn)課件19

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Barrett食管

正常食管粘膜:20GaddamS,MathurSC,SinghMetal.Novelprobe-basedconfocallaserendomicroscopycriteriaandinterobserveragreementforthedetectionofdysplasiainBarrett'sesophagus.AmJGastroenterol2011;106:1961-1969GaddamS,MathurSC,SinghMe21GaddamS,MathurSC,SinghMetal.Novelprobe-basedconfocallaserendomicroscopycriteriaandinterobserveragreementforthedetectionofdysplasiainBarrett'sesophagus.AmJGastroenterol2011;106:1961-196922GaddamS,MathurSC,SinghMeGaddamS,MathurSC,SinghMetal.Novelprobe-basedconfocallaserendomicroscopycriteriaandinterobserveragreementforthedetectionofdysplasiainBarrett'sesophagus.AmJGastroenterol2011;106:1961-1969GaddamS,MathurSC,SinghMe23

結(jié)果1.有經(jīng)驗(yàn)組與無經(jīng)驗(yàn)組診斷準(zhǔn)確率無統(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)曲線較短結(jié)果1.有經(jīng)驗(yàn)組與無經(jīng)驗(yàn)組診斷準(zhǔn)確率24操作過程KerryB.Dunbar,ElizabethA.Montgomery,MarciaI,Cantoetal.ThelearningcurveofinvivoConfocalLaserEndomicroscopyforpredictionofBarrett’sEsophagus[Abstract]19GERDwithoutknownBE58BEsurveillance41PossibleBE-associatedneoplasiaWithpriorhands–onexperienceof30supervisedcases操作過程KerryB.Dunbar,Elizabeth25

操作過程KerryB.Dunbar,ElizabethA.Montgomery,MarciaI,Cantoetal.ThelearningcurveofinvivoConfocalLaserEndomicroscopyforpredictionofBarrett’sEsophagus[Abstract]一個(gè)無經(jīng)驗(yàn)內(nèi)鏡醫(yī)師大約經(jīng)過100例的共聚焦內(nèi)鏡操作學(xué)習(xí)過程就可以掌握共聚焦內(nèi)鏡對BE食管的實(shí)時(shí)診斷操作過程KerryB.Dunbar,E26

食管上皮內(nèi)瘤變及食管癌SMS

評分法LiM,ZuoXL,YuT,etal.Surfacematurationscoringforoesophagealsquamousintraepithelialneoplasia:anoveldiagnosticapproachinspiredbyfirstendomicroscopic3-dimensionalreconstruction.Gut.2012食管上皮內(nèi)瘤變及食管癌SLiM,27

早期食管癌Studyinourcenter早期食管癌Studyinou28

食管炎癥Studyinourcenter

29

由學(xué)前培訓(xùn)約0.5h共聚焦及食管病理知識表面成熟評分法5張良性，5張瘤變Learningcurveandinter-observeragreementofconfocallaserendomicroscopyforthedetectionofprecancerousorearlystageesophagealsquamouscancersStudyinourcenter

由學(xué)前培訓(xùn)約0.5h共聚焦及食管病理知識表面成熟評分法30

觀察者診斷的準(zhǔn)確性Studyinourcenter觀察者診斷的準(zhǔn)確性Studyino31

無經(jīng)驗(yàn)組學(xué)習(xí)曲線評估Studyinourcenter無經(jīng)驗(yàn)組學(xué)習(xí)曲線評估Studyin32

診斷時(shí)間Studyinourcenter診斷時(shí)間Studyinourcen33胃（上皮內(nèi)瘤變及息肉）胃（上皮內(nèi)瘤變及息肉）34

正常胃粘膜組織胃體胃竇熒光造影劑：熒光素鈉(5ml;10%)陷凹開口柱狀上皮郭玉婷、李延青等，中華消化內(nèi)鏡雜志，200735正常胃粘膜組織胃體胃竇熒光造影LimLG,YeohKG,Salto-TellezMetal.Experiencedversusinexperiencedconfocalendoscopistsinthediagnosisofgastricadenocarcinomaandintestinalmetaplasiaonconfocalimages.GastrointestEndosc2011;73:1141-1147共聚焦內(nèi)鏡的學(xué)習(xí)與培訓(xùn)課件36LimLG,YeohKG,Salto-TellezMetal.Experiencedversusinexperiencedconfocalendoscopistsinthediagnosisofgastricadenocarcinomaandintestinalmetaplasiaonconfocalimages.GastrointestEndosc2011;73:1141-1147共聚焦內(nèi)鏡的學(xué)習(xí)與培訓(xùn)課件37LimLG,YeohKG,Salto-TellezMetal.Experiencedversusinexperiencedconfocalendoscopistsinthediagnosisofgastricadenocarcinomaandintestinalmetaplasiaonconfocalimages.GastrointestEndosc2011;73:1141-1147共聚焦內(nèi)鏡的學(xué)習(xí)與培訓(xùn)課件38LimLG,YeohKG,Salto-TellezMetal.Experiencedversusinexperiencedconfocalendoscopistsinthediagnosisofgastricadenocarcinomaandintestinalmetaplasiaonconfocalimages.GastrointestEndosc2011;73:1141-1147共聚焦內(nèi)鏡的學(xué)習(xí)與培訓(xùn)課件39

胃（上皮內(nèi)瘤變及腺癌）PittayanonR,RerknimitrR,WisedopasNetal.Thelearningcurveofgastricintestinalmetaplasiainterpretationontheimagesobtainedbyprobe-basedconfocallaserendomicroscopy.DiagnTherEndosc2012;2012:27804540胃（上皮內(nèi)瘤變及腺癌）Pittayano

胃上皮內(nèi)瘤變及腺癌PittayanonR,RerknimitrR,WisedopasNetal.Thelearningcurveofgastricintestinalmetaplasiainterpretationontheimagesobtainedbyprobe-basedconfocallaserendomicroscopy.DiagnTherEndosc2012;2012:2780451h培訓(xùn)，5段GIMpcle錄像,5段非GIMpcle錄像20videos20videos20videos20videos41胃上皮內(nèi)瘤變及腺癌PittayanonPittayanonR,RerknimitrR,WisedopasNetal.Thelearningcurveofgastricintestinalmetaplasiainterpretationontheimagesobtainedbyprobe-basedconfocallaserendomicroscopy.DiagnTherEndosc2012;2012:278045

胃上皮內(nèi)瘤變及腺癌42PittayanonR,RerknimitrR,Wi

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，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隱窩結(jié)構(gòu)可見規(guī)則伸長擴(kuò)張形狀不一致，在不同層面可見擴(kuò)張、彎曲

隱窩，間質(zhì)熒光素

大小不一的腺體開口鈉滲出及炎細(xì)胞浸潤Studyinourcenter43共聚焦顯微內(nèi)鏡下胃息肉診斷學(xué)習(xí)曲線研究共聚增生性息肉（熒光素鈉）增生性胃息肉（吖啶黃）Studyinourcenter增生性息肉（熒光素鈉）增生性胃息肉（吖啶黃44

胃腺瘤（熒光素鈉）

胃腺瘤（吖啶黃）

Studyinourcenter胃腺瘤（熒光素鈉）45材料和方法學(xué)前訓(xùn)練講明研究目的及共聚焦常識胃息肉齊魯標(biāo)準(zhǔn)學(xué)習(xí)典型15處病變學(xué)習(xí)123Studyinourcenter材料和方法學(xué)前訓(xùn)練講明研究目的及共聚焦常識胃息肉齊魯標(biāo)準(zhǔn)學(xué)習(xí)46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)部分，每個(gè)階段包含20個(gè))學(xué)習(xí)過程Studyinourcenter材料和方法第第第第80個(gè)獨(dú)立文件夾47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)階段對胃息肉診斷的準(zhǔn)確率

Studyinourcenter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)階段對胃息肉診斷的48IBDIBD49

IBDNeumannH,ViethM,AtreyaRetal.ProspectiveevaluationofthelearningcurveofconfocallaserendomicroscopyinpatientswithIBD.HistolHistopathol2011;26:867-872IBDNeumannH,Vieth50

IBDNeumannH,ViethM,AtreyaRetal.ProspectiveevaluationofthelearningcurveofconfocallaserendomicroscopyinpatientswithIBD.HistolHistopathol2011;26:867-872IBDNeumannH,Vieth51

IBDNeumannH,ViethM,AtreyaRetal.ProspectiveevaluationofthelearningcurveofconfocallaserendomicroscopyinpatientswithIBD.HistolHistopathol2011;26:867-872IBDNeumannH,Vieth52HeattendedaworkshoponCLEbeforethestudyCellvizio14UC12CDHeattendedaworkshoponCL53NeumannH,ViethM,AtreyaRetal.ProspectiveevaluationofthelearningcurveofconfocallaserendomicroscopyinpatientswithIBD.HistolHistopathol2011;26:867-872NeumannH,ViethM,AtreyaRe54NeumannH,ViethM,AtreyaRetal.ProspectiveevaluationofthelearningcurveofconfocallaserendomicroscopyinpatientswithIBD.HistolHistopathol2011;26:867-872NeumannH,ViethM,AtreyaRe55NeumannH,ViethM,AtreyaRetal.ProspectiveevaluationofthelearningcurveofconfocallaserendomicroscopyinpatientswithIBD.HistolHistopathol2011;26:867-872NeumannH,ViethM,AtreyaRe56結(jié)腸上皮內(nèi)瘤變結(jié)腸上皮內(nèi)瘤變57

KuiperT,KiesslichR,PonsioenCetal.Thelearningcurve,accuracy,andinterobserveragreementofendoscope-basedconfocallaserendomicroscopyforthedifferentiationofcolorectallesions.GastrointestEndosc2012;75:1211-1217正常粘膜

KuiperT,KiesslichR,Ponsio58KuiperT,KiesslichR,PonsioenCetal.Thelearningcurve,accuracy,andinterobserveragreementofendoscope-basedconfocallaserendomicroscopyforthedifferentiationofcolorectallesions.GastrointestEndosc2012;75:1211-1217增生性息肉KuiperT,KiesslichR,Ponsioe59KuiperT,KiesslichR,PonsioenCetal.Thelearningcurve,accuracy,andinterobserveragreementofendoscope-basedconfocallaserendomicroscopyforthedifferentiationofcolorectallesions.GastrointestEndosc2012;75:1211-1217管狀腺瘤KuiperT,KiesslichR,Ponsioe60對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)行相同的過程對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61

結(jié)果三位內(nèi)鏡醫(yī)師對3組共聚焦圖片均具有較高的診斷準(zhǔn)確率結(jié)果三位內(nèi)鏡醫(yī)師對3組共聚焦圖片均62共聚焦內(nèi)鏡的學(xué)習(xí)與培訓(xùn)課件63BuchnerAM,GomezV,HeckmanMGetal.Thelearningcurveofinvivoprobe-basedconfocallaserendomicroscopyforpredictionofcolorectalneoplasia.GastrointestEndosc2011;73:556-560BuchnerAM,GomezV,HeckmanM64

65

共聚焦內(nèi)鏡圖片學(xué)習(xí)方法一定的病理知識大約10張典型圖片的識別診斷標(biāo)準(zhǔn)把握共聚焦內(nèi)鏡圖片學(xué)習(xí)方法一定的病理知66本次培訓(xùn)班的目的和期望Itisaboutlightingfires

notfillingbuckets.本次培訓(xùn)班的目的和期望Itisaboutlig67謝謝！歡迎您到山東來！謝謝！歡迎您到山東來！68共聚焦顯微內(nèi)鏡的學(xué)習(xí)與培訓(xùn)

LearningandTrainingofConfocalEndomicroscopy齊魯醫(yī)院消化科左秀麗共聚焦顯微內(nèi)鏡的學(xué)習(xí)與培訓(xùn)

LearningandTra69

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)曲線提綱70

TheLearningPyramidTheLearningPyramid71

The

TrainingEthos?TellmeandIforget?ShowmeandIremember?InvolvemeandIlearn--BenjaminFranklinTheTrainingEthos72

怎樣學(xué)習(xí)效果最好Adultslearnbestwhen:TheyaremotivatedThelearningisrelevantTheaimsandobjectivesareclearTheyareactivelyinvolvedAvarietyoflearningmethodsisusedTheygetfeedbackItisFUN!怎樣學(xué)習(xí)效果最好73“Theabilitytoestablishanimmediateendoscopicdiagnosisthatisvirtuallyconsistentwiththehistologicdiagnosishasbeentheultimateobjectiveofendoscopistssincetheveryearliestphasesofthedevelopmentofendoscopy.”Kudo,GastrointestEndosc1996

共聚焦激光顯微內(nèi)鏡是一種革命“Theabilitytoestablishani74

共聚焦激光顯微內(nèi)鏡是一種趨勢共聚焦激光顯微內(nèi)75

兩種共聚焦內(nèi)鏡比較兩種共聚焦內(nèi)鏡比較76

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

(通過鉗道使用噴管進(jìn)行，顯示細(xì)胞核）兩種主要的造影劑熒光素鈉77熒光素鈉染色熒光素鈉染色78

吖啶黃染色吖啶黃染色79

怎樣學(xué)習(xí)共聚焦內(nèi)鏡？圖片識別操作過程怎樣學(xué)習(xí)共聚焦內(nèi)鏡？圖片識別操作過程80

識圖面臨的困惑?是否需要掌握足夠多的病理知識呢?是否很難掌握呢？請跟隨以下的幾篇共聚焦內(nèi)鏡學(xué)習(xí)曲線研究一起來認(rèn)識共聚焦圖片以及了解共聚焦學(xué)習(xí)的難易程度。識圖面臨的困惑?是否需要掌握足夠多的病81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)82食管病變食管病變83

食

管84食管16共聚焦內(nèi)鏡的學(xué)習(xí)與培訓(xùn)課件85共聚焦內(nèi)鏡的學(xué)習(xí)與培訓(xùn)課件86共聚焦內(nèi)鏡的學(xué)習(xí)與培訓(xùn)課件87

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Barrett食管

正常食管粘膜:88GaddamS,MathurSC,SinghMetal.Novelprobe-basedconfocallaserendomicroscopycriteriaandinterobserveragreementforthedetectionofdysplasiainBarrett'sesophagus.AmJGastroenterol2011;106:1961-1969GaddamS,MathurSC,SinghMe89GaddamS,MathurSC,SinghMetal.Novelprobe-basedconfocallaserendomicroscopycriteriaandinterobserveragreementforthedetectionofdysplasiainBarrett'sesophagus.AmJGastroenterol2011;106:1961-196990GaddamS,MathurSC,SinghMeGaddamS,MathurSC,SinghMetal.Novelprobe-basedconfocallaserendomicroscopycriteriaandinterobserveragreementforthedetectionofdysplasiainBarrett'sesophagus.AmJGastroenterol2011;106:1961-1969GaddamS,MathurSC,SinghMe91

結(jié)果1.有經(jīng)驗(yàn)組與無經(jīng)驗(yàn)組診斷準(zhǔn)確率無統(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)曲線較短結(jié)果1.有經(jīng)驗(yàn)組與無經(jīng)驗(yàn)組診斷準(zhǔn)確率92操作過程KerryB.Dunbar,ElizabethA.Montgomery,MarciaI,Cantoetal.ThelearningcurveofinvivoConfocalLaserEndomicroscopyforpredictionofBarrett’sEsophagus[Abstract]19GERDwithoutknownBE58BEsurveillance41PossibleBE-associatedneoplasiaWithpriorhands–onexperienceof30supervisedcases操作過程KerryB.Dunbar,Elizabeth93

操作過程KerryB.Dunbar,ElizabethA.Montgomery,MarciaI,Cantoetal.ThelearningcurveofinvivoConfocalLaserEndomicroscopyforpredictionofBarrett’sEsophagus[Abstract]一個(gè)無經(jīng)驗(yàn)內(nèi)鏡醫(yī)師大約經(jīng)過100例的共聚焦內(nèi)鏡操作學(xué)習(xí)過程就可以掌握共聚焦內(nèi)鏡對BE食管的實(shí)時(shí)診斷操作過程KerryB.Dunbar,E94

食管上皮內(nèi)瘤變及食管癌SMS

評分法LiM,ZuoXL,YuT,etal.Surfacematurationscoringforoesophagealsquamousintraepithelialneoplasia:anoveldiagnosticapproachinspiredbyfirstendomicroscopic3-dimensionalreconstruction.Gut.2012食管上皮內(nèi)瘤變及食管癌SLiM,95

早期食管癌Studyinourcenter早期食管癌Studyinou96

食管炎癥Studyinourcenter

97

由學(xué)前培訓(xùn)約0.5h共聚焦及食管病理知識表面成熟評分法5張良性，5張瘤變Learningcurveandinter-observeragreementofconfocallaserendomicroscopyforthedetectionofprecancerousorearlystageesophagealsquamouscancersStudyinourcenter

由學(xué)前培訓(xùn)約0.5h共聚焦及食管病理知識表面成熟評分法98

觀察者診斷的準(zhǔn)確性Studyinourcenter觀察者診斷的準(zhǔn)確性Studyino99

無經(jīng)驗(yàn)組學(xué)習(xí)曲線評估Studyinourcenter無經(jīng)驗(yàn)組學(xué)習(xí)曲線評估Studyin100

診斷時(shí)間Studyinourcenter診斷時(shí)間Studyinourcen101胃（上皮內(nèi)瘤變及息肉）胃（上皮內(nèi)瘤變及息肉）102

正常胃粘膜組織胃體胃竇熒光造影劑：熒光素鈉(5ml;10%)陷凹開口柱狀上皮郭玉婷、李延青等，中華消化內(nèi)鏡雜志，2007103正常胃粘膜組織胃體胃竇熒光造影LimLG,YeohKG,Salto-TellezMetal.Experiencedversusinexperiencedconfocalendoscopistsinthediagnosisofgastricadenocarcinomaandintestinalmetaplasiaonconfocalimages.GastrointestEndosc2011;73:1141-1147共聚焦內(nèi)鏡的學(xué)習(xí)與培訓(xùn)課件104LimLG,YeohKG,Salto-TellezMetal.Experiencedversusinexperiencedconfocalendoscopistsinthediagnosisofgastricadenocarcinomaandintestinalmetaplasiaonconfocalimages.GastrointestEndosc2011;73:1141-1147共聚焦內(nèi)鏡的學(xué)習(xí)與培訓(xùn)課件105LimLG,YeohKG,Salto-TellezMetal.Experiencedversusinexperiencedconfocalendoscopistsinthediagnosisofgastricadenocarcinomaandintestinalmetaplasiaonconfocalimages.GastrointestEndosc2011;73:1141-1147共聚焦內(nèi)鏡的學(xué)習(xí)與培訓(xùn)課件106LimLG,YeohKG,Salto-TellezMetal.Experiencedversusinexperiencedconfocalendoscopistsinthediagnosisofgastricadenocarcinomaandintestinalmetaplasiaonconfocalimages.GastrointestEndosc2011;73:1141-1147共聚焦內(nèi)鏡的學(xué)習(xí)與培訓(xùn)課件107

胃（上皮內(nèi)瘤變及腺癌）PittayanonR,RerknimitrR,WisedopasNetal.Thelearningcurveofgastricintestinalmetaplasiainterpretationontheimagesobtainedbyprobe-basedconfocallaserendomicroscopy.DiagnTherEndosc2012;2012:278045108胃（上皮內(nèi)瘤變及腺癌）Pittayano

胃上皮內(nèi)瘤變及腺癌PittayanonR,RerknimitrR,WisedopasNetal.Thelearningcurveofgastricintestinalmetaplasiainterpretationontheimagesobtainedbyprobe-basedconfocallaserendomicroscopy.DiagnTherEndosc2012;2012:2780451h培訓(xùn)，5段GIMpcle錄像,5段非GIMpcle錄像20videos20videos20videos20videos109胃上皮內(nèi)瘤變及腺癌PittayanonPittayanonR,RerknimitrR,WisedopasNetal.Thelearningcurveofgastricintestinalmetaplasiainterpretationontheimagesobtainedbyprobe-basedconfocallaserendomicroscopy.DiagnTherEndosc2012;2012:278045

胃上皮內(nèi)瘤變及腺癌110PittayanonR,RerknimitrR,Wi

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，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隱窩結(jié)構(gòu)可見規(guī)則伸長擴(kuò)張形狀不一致，在不同層面可見擴(kuò)張、彎曲

隱窩，間質(zhì)熒光素

大小不一的腺體開口鈉滲出及炎細(xì)胞浸潤Studyinourcenter111共聚焦顯微內(nèi)鏡下胃息肉診斷學(xué)習(xí)曲線研究共聚增生性息肉（熒光素鈉）增生性胃息肉（吖啶黃）Studyinourcenter增生性息肉（熒光素鈉）增生性胃息肉（吖啶黃112

胃腺瘤（熒光素鈉）

胃腺瘤（吖啶黃）

Studyinourcenter胃腺瘤（熒光素鈉）113材料和方法學(xué)前訓(xùn)練講明研究目的及共聚焦常識胃息肉齊魯標(biāo)準(zhǔn)學(xué)習(xí)典型15處病變學(xué)習(xí)123Studyinourcenter材料和方法學(xué)前訓(xùn)練講明研究目的及共聚焦常識胃息肉齊魯標(biāo)準(zhǔn)學(xué)習(xí)114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)部分，每個(gè)階段包含20個(gè))學(xué)習(xí)過程Studyinourcenter材料和方法第第第第80個(gè)獨(dú)立文件夾115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)階段對胃息肉診斷的準(zhǔn)確率

Studyinourcenter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)階段對胃息肉診斷的116IBDIBD117

IBDNeumannH,ViethM,AtreyaRetal.ProspectiveevaluationofthelearningcurveofconfocallaserendomicroscopyinpatientswithIBD.HistolHistopathol2011;26:867-872IBDNeumannH,Vieth118

IBDNeumannH,ViethM,AtreyaRetal.ProspectiveevaluationofthelearningcurveofconfocallaserendomicroscopyinpatientswithIBD.HistolHistopathol2011;26:867-872IBDNeumannH,Vieth119

IBDNeumannH,ViethM,AtreyaRetal.ProspectiveevaluationofthelearningcurveofconfocallaserendomicroscopyinpatientswithIBD.HistolHistopathol2011;26:867-872IBDNeumannH,Vieth120HeattendedaworkshoponCLEbeforethestudyCellvizio14UC12CDHeattendedaworkshoponCL121Neuma