Tonelli Pietro, Martellucci Jacopo, Lucchese Marcello, Comin Camilla E, Bergamini Carlo, Pedica Federica, Bargellini Tatiana, Valeri Andrea
Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Surg Innov. 2014 Aug;21(4):381-8. doi: 10.1177/1553350613508017. Epub 2013 Nov 19.
Recently, the lymphatic vessels has been considered to play a key role in the pathophysiology and, consequently, in the treatment of Crohn's disease (CD). The aim of this study is to show that the evaluation of lymphatic anomaly might be a useful tool in the recognition of the pathological involvement of the intestinal wall in CD.
Fourteen patients with CD who underwent surgical treatment for distal ileum critical stenosis were prospectively evaluated. During surgery, 0.05 to 0.1 mL of Patent Blue V was injected into the subserosal layer of the antimesenteric edge of ileum and colon. The intestinal section was performed just beneath the outflow of the vital dye where it seemed to be normal (≤2 minutes), as a index of healthy intestinal wall. A comparison between the lymphatic alterations and the macroscopic aspects was performed.
Out of 14 patients, 13 were electively operated on, whereas 1 was treated in emergency. In 8 patients (57%), laparoscopic approach was chosen in the first instance. One patient needed laparotomic conversion. When comparing the Patent Blue V outflow time with the macroscopic and microscopic evidence of CD, we found an absolute integrity of the intestinal wall with an outflow ≤2 minutes. Mean follow-up was 110 months with a recurrence rate of 14%.
We can conclude that this method may be of utility to distinguish between normal and diseased intestine in CD. The possible consequences in postsurgical recurrences of this evidence are critical.
最近，淋巴管被认为在克罗恩病（CD）的病理生理学中发挥关键作用，因此在其治疗中也起着关键作用。本研究的目的是表明，评估淋巴管异常可能是识别CD肠壁病理累及情况的有用工具。
对14例因回肠末端严重狭窄接受手术治疗的CD患者进行前瞻性评估。手术过程中，将0.05至0.1 mL专利蓝V注入回肠和结肠系膜对侧缘的浆膜下层。在活性染料流出似乎正常的部位（≤2分钟）正下方进行肠段切除，作为健康肠壁的指标。对淋巴管改变与宏观表现进行了比较。
14例患者中，13例择期手术，1例急诊手术。8例患者（57%）首先选择了腹腔镜手术方式。1例患者需要转为开腹手术。将专利蓝V流出时间与CD的宏观和微观证据进行比较时，我们发现肠壁绝对完整，流出时间≤2分钟。平均随访110个月，复发率为14%。
我们可以得出结论，这种方法可能有助于区分CD患者的正常肠段和病变肠段。这一证据在术后复发中的可能后果至关重要。
