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中华眼科医学杂志(电子版)

中华眼科医学杂志(电子版) ›› 2018, Vol. 08 ›› Issue (03) : 134 -139. doi: 10.3877/cma.j.issn.2095-2007.2018.03.007

所属专题： 文献；

综述

反射式共聚焦显微镜在眼睑肿物诊治中的应用现状
宋航1, 张艳2, 江晓丹1, 张小艳1, 李学民1,†()   
  1. 1. 100191　北京大学附属第三医院眼科
    2. 130033　长春，吉林大学中日联合医院眼科
  • 收稿日期:2018-03-03 出版日期:2018-06-28
  • 通信作者: 李学民
  • 基金资助:
    国家科技重大专项基金项目(2018ZX10101004)

Application of reflection confocal microscopy in diagnosis and treatment of eyelid tumor

Hang Song1, Yan Zhang2, Xiaodan Jiang1, Xiaoyan Zhang1, Xuemin Li1,†()   

  1. 1. Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
    2. Department of Ophthalmology, Sino-Japanese Union Hospital of Jilin University, Changchun 130033, China
  • Received:2018-03-03 Published:2018-06-28
  • Corresponding author: Xuemin Li
  • About author:
    Corresponding author: Li Xuemin, Email:
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引用本文：

宋航, 张艳, 江晓丹, 张小艳, 李学民. 反射式共聚焦显微镜在眼睑肿物诊治中的应用现状[J]. 中华眼科医学杂志(电子版), 2018, 08(03): 134-139.

Hang Song, Yan Zhang, Xiaodan Jiang, Xiaoyan Zhang, Xuemin Li. Application of reflection confocal microscopy in diagnosis and treatment of eyelid tumor[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2018, 08(03): 134-139.

反射式共聚焦显微镜(RCM)是对活体组织进行无创观察的新型高分辨率显微镜，也是一种新兴的无创影像学检查手段。此方法可以观察皮肤组织的层次结构和病灶特点。眼睑肿物的手术治疗涉及面部美观及眼睑的功能保留，故眼睑手术术前对肿物良性或恶性的初步鉴别及肿物性质和边界的初步判定是十分重要的。不同的眼睑肿物在RCM下具有各自的特征，故RCM在眼睑肿物的初步筛查中具有一定的作用，并可推广应用于术前眼睑肿物性质判断和术后的随访中，在临床中具有良好的应用前景。

关键词: 反射式共聚焦显微镜, 眼睑肿物, 基底细胞癌, 恶性黑色素瘤, 鳞状细胞癌

Reflection confocal microscope(RCM) is a new high-resolution imaging microscope for noninvasive observation of living tissues. It is also a new non-invasive imaging examination method. This method can observe the skin tissue hierarchy and lesion characteristics. The surgical treatment of eyelid tumor involves the beauty of the face and the retention of the function of the eyelids, so it is very important for the preliminary identification of benign and malignant tumors, the nature of the tumor and the preliminary determination of the boundary before the eyelid operation. Different eyelid masses have their own characteristics under the RCM, so the RCM plays a certain role in the preliminary screening of eyelid mass, and can be applied to the diagnosis of eyelid mass and the follow-up of postoperative palpebral mass, and it has a good prospect in clinical application.

Key words: Reflection confocal microscope, Eyelid tumor, Basal cell carcinoma, Malignant melanoma, Squamous cell carcinoma
图1 基底细胞癌RCM检查的图像与病理切片的对照　A图为RCM检查图像与病理切片的对照；B图为基底细胞癌的病理切片　苏木精－伊红染色×400。A图与B图均可见结节状癌巢。癌巢内延长的单一形态的细胞核沿同一方向极化，呈轮辐状(红色星号)；癌巢高反光的轮廓(白色指针)为偏心极化的细胞核栅栏状表现；RCM的检查图像与病理切片均可见癌巢之间有裂隙(绿色箭头)[15]
图2 汗管腺瘤外观、RCM检查的图像　A图为患眼外部表现；B图与C图为RCM检查图像；D图为RCM检查下的病理切片　苏木精－伊红染色×100。B图与C图均可见褐色的轮廓内包含不同反光度的细胞(白色星号)；C图可见迂曲血管(红色箭头)。此类特征易与基底细胞癌的特征相混淆[23]
图3 皮脂腺增生RCM检查的图像与病理切片的对照　A图为RCM检查图像；B图为皮脂腺增生的病理切片　苏木精－伊红染色×200。A图与B图均可见增大的腺体轮廓，内含细胞核位于中央的柱状细胞[25]
图4 黑色素瘤RCM检查的图像与病理切片的对照　A图为RCM检查图像；B图为黑色素瘤的病理切片　苏木精－伊红染色×100。RCM图像可见上皮结构物较乱，有较大的高反光圆形(蓝色箭头)和树突状(红色箭头)帕哲样网状细胞细胞[28]
图5 色素痣RCM检查的图像与病理切片的对照　1A图为交界痣RCM检查图像，表现为环状结构；2A图为交界痣的病理切片　苏木精－伊红染色×200，组织学上表现为单一形态的、规则的黑色素细胞增生；1B图为复合痣的RCM检查图像，表现为网状结构，真皮乳头被网状高亮结构分隔；2B图为交界痣RCM检查下的病理切片　苏木精－伊红染色×200，组织学上表现为细胞巢在真皮表皮交界处增生；1C图为皮内痣的RCM检查图像，表现为土块状结构；2C图为皮内痣RCM检查下的病理切片　苏木精－伊红染色×200，组织学上表现为真皮内出现黑色素细胞巢[36]
图6 鳞状细胞癌RCM检查的图像与病理切片的对照　A图为RCM检查图像；B图为鳞状细胞癌的病理切片　苏木精－伊红染色×100。A图可见非典型的蜂窝状表皮结构(圆圈)；A图和B图均可见真皮乳头层乳头增多并伴有粗大圆形的血管截面，垂直于肿瘤表面(白色箭头)[39]
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