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<section data-role="paragraph" data-color="rgb(182, 228, 253)" data-custom="rgb(182, 228, 253)"><section><section><section><section powered-by="gulangu"><section><section><section><section powered-by="gulangu"><section><section><section><section powered-by="gulangu"><section><section><section><section powered-by="gulangu"><section><section><section><section><p><p><img src="image/20201019/86b79d371e9862b01189f0252a03b2cd_1.png" /></p></p></section><section><section><span><strong>器械之家</strong></span></section><p><span>医疗器械媒体报道先锋</span></p><p><span>分享专业医疗器械知识</span></p></section><section><section><section><span>关注</span></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section><p><br /></p><p><span><span>人类对自己身体的探索从未停止，古希腊名医，有着医学之父之称的希波克拉底曾描述过一种直肠诊视器，该诊视器与</span>我们<span>今天所用的器械十分相似。进入20世纪随着科技的进步，内窥镜开始了快速的发展。</span></span><br /></p><p><span><br /></span></p><section><p><img src="image/20201019/a8554d88a352f23fba2b566b21f01383_2.jpg" /></p></section><p><br /></p><section data-role="outer" label=" owered by gulangu"><section data-tools="gulangu" data-id="32290" data-color="#27939d"><section><section><section><section><section data-bcless="darken" data-brushtype="text">50年代内窥镜初具雏形</section><section></section></section></section></section></section></section><section data-role="paragraph" data-color="#27939d"><p><br /></p></section></section><p><p><img src="image/20201019/f0a03ba6e75f276e3b98d4601bf22dd5_3.jpg" /></p></p><section><span><br /></span></section><section><span>与现有内窥镜成像效果相比，20世纪50年代以前内窥镜照明采用的是内光源，照明效果较差，图像色彩扭曲，并有致组织灼伤的危险。为了应对这个问题，荷兰Heel及美国Brien尝试在纤维上加一被覆层，解决了纤维间的光绝缘问题。</span></section><section><span><br /></span></section><section><span>1954年英国Hopkings及Kapany研究了纤维的精密排列，有效地解决了纤维束的图像传递，为纤维光学的实用奠定了基础。</span></section><section><span><br /></span></section><section><span>1956年，Wild和Reid最早将机械旋转超声探头应用于经直肠腔内超声诊断前列腺疾患，一些无内镜视野的腔内超声探头在直肠、妇科及泌尿科疾病诊断中得到应用。</span></section><section><br /></section><section data-role="outer" label="owered by gulangu"><section data-tools="gulangu" data-id="32290" data-color="#27939d"><section><section><section><section><section data-bcless="darken" data-brushtype="text">60年代内窥镜逐渐发展成型</section><section></section></section></section></section></section></section><section data-role="paragraph" data-color="#27939d"><p><br /></p></section></section><p><p><img src="image/20201019/86b4f0939186d99584261eb98f2d872f_4.jpg" /></p></p><section><span><br /></span></section><section><span>1960年10月美国膀胱镜制造者公司(ACMI)向Hirschowitz提供了第一个商业纤维内窥镜，紧接着日本Olympus厂在光导纤维胃镜基础上，加装了活检装置及照相机，有效地显示了胃照相术。</span></section><section><span><br /></span></section><section><span>Olympus厂首创前端弯角机构，Machida厂采用外部冷光源，使光亮度大增，可发现小病灶，视野进一步扩大，可以观察到十二指肠。随着附属装置的不断改进，如手术器械、摄影系统的发展，使纤维内镜不但可用于诊断，且可用于手术治疗。</span></section><section><br /></section><section data-role="outer" label="owered by gulangu"><section data-tools="gulangu" data-id="32290" data-color="#27939d"><section><section><section><section><section data-bcless="darken" data-brushtype="text">80年代的超声内窥镜迎来复合成像时代</section><section></section></section></section></section></section></section><section data-role="paragraph" data-color="#27939d"><p><br /></p></section></section><p><p><img src="image/20201019/10b43a908c7326cc6857f6feacf54864_5.jpg" /></p></p><section><span><br /></span></section><section><span>具有内镜视野的超声内窥镜出现于1980年，</span><span>Dimagno首次成功将电子线阵超声内镜用于动物实验，并首次提出“<span>Ultrasonic endoscope</span>（超声内窥镜）”一词，在超声内窥镜的发展史上具有划时代的意义。</span><span>1984-1987年间，相继报道了超声内镜对十二指肠乳头癌浸润范围、食管及胃癌淋巴结转移、黏膜下肿瘤及胃溃疡等消化疾病的诊断，以及超声内镜对消化道疾病内镜下治疗的疗效判断。</span></section><section></section><section><span><br /></span></section><section data-role="outer" label="owered by gulangu"><section data-tools="gulangu" data-id="32290" data-color="#27939d"><section><section><section><section><section data-bcless="darken" data-brushtype="text">90年代复合成像趋于成熟</section><section></section></section></section></section></section></section><section data-role="paragraph" data-color="#27939d"><p><br /></p></section></section><section><span></span></section><section><span><strong><span><br /></span></strong></span></section><p><p><img src="image/20201019/d4cd9e009cdf2ef58c8291f7eb1e69ef_6.jpg" /></p></p><section><br /></section><p><span>从20世纪90年代初开始，超声内镜引导下的介入诊断和治疗技术逐步应用于临床，并取得了蓬勃发展，成为消化道、胆胰疾病诊疗不可或缺的技术手段。1990年，日本原田等报道了超声内镜下穿刺法的基础研究，经内镜下食管静脉穿刺成功地对犬的食管旁淋巴结进行针吸活检。</span></p><section><br /></section><section></section><p><span>1992年Vilmann等首次报道了内镜超声引导下胰腺病变的细针吸取细胞学检查，即通常所说的EUS-FNA（Endoscopic ultrasonography guided fine needle aspiration）。此后，EUS引导下细针穿刺活检拓展到经支气管针吸活检。EUS特别是EUS引导下的介入诊断技术在某些方面（如微小病灶诊断，病变性质判定，肿瘤分期准确性等）已展现出CT、MRI、ERCP、MRCP等影像学技术难以比拟的优势，可与现有其他影像技术联合提高诊断准确性。</span></p><p><br /></p><p><span>随着临床应用的不断深入，超声内镜技术的发展也日新月异。例如，基于CCD/CMOS图像传感器的电子胃肠镜取代纤维胃肠镜，使超声内镜的光学图像分辨率也得到了显著提升；具备更大超声视野的纵轴扫描超声内镜、提供更大钳道的超声内镜的开发，使EUS引导下的介入诊疗更加便捷；具有三维重建功能、二次谐波成像、造影谐波成像及弹性成像功能的新技术也在超声内镜中得到应用。</span></p><section><br /></section><section data-role="outer" label="owered by gulangu"><section data-tools="gulangu" data-id="32290" data-color="#27939d"><section><section><section><section><section data-bcless="darken" data-brushtype="text">现今的超声内窥镜</section><section></section></section></section></section></section></section><section data-role="paragraph" data-color="#27939d"><p><br /></p></section></section><p><br /></p><section><span><p><img src="image/20201019/203a8c1f1ab9596bba18fa4d2d2cec18_7.jpg" /></p></span></section><section><span>技术的进步和临床应用的深入，不断推动着超声内窥镜技术的发展，使超声内窥镜在探头细径化、变频、兼容性及图像处理自动化方面取得了长足进步。</span><br /></section><section><span><br /></span></section><p><p><img src="image/20201019/4de436901f85c5afbea8d7004e970440_8.jpg" /></p></p><section><br /></section><section><span>探头的细径化有利于改善操控性，提升患者耐受，同时可以到达普通探头难以到达的组织区域，扩展超声内镜诊疗的应用范围。随着各种细径、超细径导管式探头（intraductal ultrasound，IDUS），尤其是三维超声探头的应用，胆胰管内超声技术也日趋成熟。</span></section><section></section><section><span><br /></span></section><p><br /></p><section><span><p><img src="image/20201019/09fc1e266aaca6e416b9f88915523dc0_9.jpg" /></p></span></section><section><span>探头的变频技术可以实现一次插入获得多种深度显示，探头的频率范围越广，越有利于医生对不同深度的组织进行病灶探查。目前Olympus与Fujifilm的电子扫描超声内窥镜可在5-12MHz的频率范围内多档可调，Pentax的电子扫描超声内窥镜可在5-10MHz的频率范围内调节。</span></section><section><span><br /></span></section><section><p><img src="image/20201019/3731145c88ad2a8b969c46f1fb25455c_10.jpg" /></p></section><section><span><br /></span></section><section><span>在兼容性方面，超声内窥镜的超声图像处理器能够支持多种类型和频率范围的超声内镜镜体。Olympus的EU-ME2超声图像处理器还能够同时兼容电子扫描超声内镜镜体和机械扫描超声微探头，支持的超声频率范围为5-20MHz。</span></section><section><span><br /></span></section><section></section><p><span>此外，目前超声内窥镜的超声图像处理器能够支持普通B超、彩色多普勒超声成像、二次谐波超声成像、造影谐波成像、超声弹性成像、三维超声成像等多种成像模式。</span><span>未来超声内窥镜还将可能与虚拟导航、共聚焦激光扫描显微成像、光学相干层析成像、光声成像等技术结合或深度整合，拓展超声内窥镜的临床应用领域。</span></p><p><br /></p><section data-role="outer" label="owered by gulangu"><section data-tools="gulangu" data-id="32290" data-color="#27939d"><section><section><section><section><section data-bcless="darken" data-brushtype="text">目前市场主流内窥镜厂家</section><section></section></section></section></section></section></section></section><p><br /></p><p><span>目前国外超声内窥镜技术的发展和临床应用已经比较成熟。无论国际或国内，超声内窥镜市场基本都被日本三大内窥镜厂商垄断。</span></p><p><span><br /></span></p><p><p><img src="image/20201019/0cda46f7b21a8e62ac5b12da49d7f0d7_11.jpg" /></p></p><p><br /></p><p><span>Olympus是国际上最早开展超声内窥镜研发的公司之一。早在1980年，Olympus即与Aloka合作研制了机械环扫式超声探头。Olympus还推出了世界首台兼容机械扫描与电子扫描的超声图像处理器EUS-ME1。目前，Olympus是拥有规格最多、种类最全的电子扫描超声内窥镜图像处理器、镜体及微探头的厂商。</span></p><p><span><br /></span></p><p><span></span></p><p><span>Fujifilm通过收购Sonosite开始超声内镜研发，并推出了具有自己特色的超声内镜主机、镜体及微探头系列产品。</span><span>例如，其超声内镜图像处理器SU-8000兼容环阵和线阵电子超声内镜，同时提供独有的穿刺引导线，保证穿刺的准确性。</span><br /></p><p><span><br /></span></p><p><p><img src="image/20201019/813c7d2820501426f9ed640ac7a89a4e_12.jpg" /></p></p><p><br /></p><p><span>entax的超声内窥镜镜系统采用Hitachi的超声换能器及超声系统HI VISION Preirus，其超声图像质量高，但镜体操控性稍差。</span></p><p><span><br /></span></p><p><span>开立医疗2017年推出了国产首台电子环扫超声内窥镜EG-UR5样机，现已取得CE认证，使开立医疗成为继日本三大内镜厂商之后国内首家、世界第四家掌握超声内镜关键核心技术的医疗器械企业。</span></p><p><span><br /></span></p><p><br /></p><p><span><br /></span></p><p><p><img src="image/20201019/c4e76bc0d51c3db173b04d248aa38b69_13.jpg" /></p></p><p><br /><span></span></p><section><span>参考文献</span></section><section><span>[1] Dimagno EP, Buxton JL, Regan PT, et al. Ultrasonic endoscope. Lancet, 1980, 1:629-931.</span></section><section><span>[2] Vilmann P, Hancke S, Henriksen FW, et al. Endosonographically-guided fine needle aspiration biopsy of malignant lesion in the upper gastrointestinal tract. Endoscopy, 1993, 25(8): 523-527.</span></section><section><span>[3] Mohammad Alizadeh AH, Shahrokh S, Hadizadeh M, et a1. Diagnostic potency of EUS-guided FNA for the evaluation of pancreatic mass lesions. Endosc Ultrasound. 2016 Jan-Feb; 5(1): 30-4. </span></section><section><span>[4] Bhutani MS, Koduru P, Joshi V, et a1. The role of endoscopic ultrasound in pancreatic cancer screening. Endosc Ultrasound. 2016 Jan-Feb; 5(1): 8-16. </span></section><section><span>[5] Puri R, Manrai M, Thandassery RB, et a1. Endoscopic ultrasound in the diagnosis and management of carcinoma pancreas. World J Gastrointest Endosc. 2016 Jan 25; 8(2): 67-76. </span></section><section><span>[6] Mayerle J, Beyer G, Simon P, et al. Prospective cohort study comparing transient EUS guided elastography to EUS-FNA for the diagnosis of solid pancreatic mass lesions. ancreatology. 2016 Jan-Feb; 16(1): 110-4. </span></section><section><span>[7] Kamata K, Kitano M, Omoto S, et al. Contrast-enhanced harmonic endoscopic ultrasonography </span></section><section><span><br /></span></section><section data-role="outer" label="owered by gulangu"><section data-tools="gulangu" data-id="93679" data-color="#27939d"><section><section></section><section><p><img src="image/20201019/cfdebbe5ed51145a32d1b03d73c832a7_14.jpg" /></p></section><section data-width="100%"></section></section></section><section data-role="paragraph" data-color="#27939d"><p><br /></p></section></section><section><span></span></section><p><a data-miniprogram-appid="wxdc7efe409d688f37" data-miniprogram-path="pages/index/index" data-miniprogram-nickname="器械之家" href="" data-miniprogram-type="image" data-miniprogram-servicetype="" href=""><p><img src="image/20201019/9b56b340737aeb94a7591bcbc4044481_15.gif" /></p></a></p><p><br /></p><section data-role="outer" label="owered by gulangu"><section data-role="paragraph" data-color="#757576"><section data-role="paragraph"><section><section><section data-brushtype="text"><strong>相关阅读</strong></section></section></section><section><section></section></section><section data-width="100%"><section><section><section><section data-width="100%"><section data-tools="gulangu" data-id="87578" data-color="#6aa9ad" data-custom="#59c3f9"><section><p><img src="image/20201019/2aac877ff9233ba5a66e7a5ff3a4febf_16.gif" /></p></section><section data-brushtype="text">戳一下，更有料！</section></section><section data-tools="gulangu" data-id="87578" data-color="#6aa9ad" data-custom="#59c3f9"></section><section data-tools="gulangu" data-id="87578" data-color="#6aa9ad" data-custom="#59c3f9"><section data-tools="gulangu" data-id="87578" data-color="#6aa9ad" data-custom="#59c3f9"><section data-brushtype="text"><br /></section><section data-brushtype="text"><span>开立医疗携两款全新智能新品亮相CMEF！</span><br /></section><section data-brushtype="text"><br /></section><section data-brushtype="text"><span>开立发布新款内窥镜和超声，图像更清晰，功能更强大！</span></section></section></section></section></section></section></section></section></section></section></section><p><br /></p><p><p><img src="image/20201019/aad9f56b0707b5374bbac6273a663447_17.jpg" /></p></p> |
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发表于 2020-10-19 09:43:25