淋巴状态与克罗恩病炎症消退有关吗？
Is lymphatic status related to regression of inflammation in Crohn's disease?
机构信息
Francesco Tonelli, Francesco Giudici, Gadiel Liscia, Department of Clinical Physiopathology, University of Florence, Surgical Unit, 50134 Florence, Italy.
出版信息
World J Gastrointest Surg. 2012 Oct 27;4(10):228-33. doi: 10.4240/wjgs.v4.i10.228.
AIM
To investigate the status of the lymphatic vessels in the small bowel affected by Crohn's disease (CD) at the moment of surgery.
METHODS
During the period January 2011-June 2011, 25 consecutive patients affected by CD were operated on in our Institution. During surgery, Patent Blue V was injected subserosally and the way it spread along the subserosa of the intestinal wall, through the mesenterial layers towards the main lymphatic collectors and eventually to the lymph nodes was observed and recorded. Since some patients had been undergone strictureplasty at previous surgery, we also examined the status of intestinal lymph vessels after previous strictureplasties. The same procedure was performed in a control group of 5 patients affected by colorectal cancer. Length of lesions, caliber, maximal thickness of the diseased intestinal wall, thickness of the wall at injection site and thickness of the mesentery were evaluated at surgery.
RESULTS
We observed three features after the injection of Patent Blue V in the intestinal loops: (1) Macroscopically healthy terminal ileum of patients with CD or colon cancer showed thin lymphatic vessels linearly directed toward the mesentery; (2) In mild lesions in which the intestinal wall did not reach 8 mm of thickness, we observed short, wide and tortuous lymphatic vessels directed longitudinally along the intestinal axis toward disease-free areas and then transversally toward the mesentery; and (3) Injection in the severely affected lesions, that had a thickness of the intestinal wall over 10 mm, did not show any feature of lymphatic vessels at least on the subserosal surface. There was a correlation between the thickness of the parietal wall and the severity of the lymphatic alterations. Normal lymphatic vessels were observed at previous strictureplasties in the presence of complete regression of the inflammation.
CONCLUSION
Injection of Patent Blue V in the intestinal wall could help distinguish healthy tracts of the small bowel from those macroscopically borderline.
目的
研究克罗恩病（CD）手术时小肠受累淋巴管的状态。
方法
2011 年 1 月至 2011 年 6 月期间，我院对 25 例连续 CD 患者进行手术治疗。手术中，将专利蓝 V 皮下注射，观察并记录其沿肠壁浆膜下扩散、穿过肠系膜层向主要淋巴管收集器最终到达淋巴结的方式。由于部分患者之前曾行狭窄成形术，我们还检查了既往狭窄成形术后肠淋巴管的状态。对 5 例结直肠癌患者进行了相同的程序。术中评估病变长度、口径、病变肠壁最大厚度、注射部位肠壁厚度和肠系膜厚度。
结果
我们观察到在肠袢中注射专利蓝 V 后出现三种特征：（1）CD 或结肠癌患者的肉眼正常末端回肠显示出线性指向肠系膜的细淋巴管；（2）在肠壁厚度未达到 8 毫米的轻度病变中，我们观察到短、宽且扭曲的淋巴管沿肠轴纵向朝向无病变区域，然后横向朝向肠系膜；（3）在肠壁厚度超过 10 毫米的严重病变中进行注射，至少在浆膜表面没有发现任何淋巴管特征。壁层厚度与淋巴管改变的严重程度之间存在相关性。在炎症完全消退的情况下，既往狭窄成形术时可见正常淋巴管。
结论
在肠壁注射专利蓝 V 有助于区分小肠的健康区域和宏观上边界的区域。
Zotero 插件