Dost P
Abteilung für Hals-Nasen-Ohren-Heilkunde, Plastische Operationen, Marienhospital Gelsenkirchen -- Medizinische Fakultät der Universität Duisburg-Essen.
HNO. 2006 Jan;54(1):16-9. doi: 10.1007/s00106-005-1302-6.
The histological examination of lymphatic tissue resected in children during adenoidectomy or tonsillectomy has to be considered as a screening method. Its purpose is to detect rare diseases that differ from "chronic inflammation" or "lymphatic hyperplasia". That this examination is economically reasonable in relation to the frequency of surprising results with therapeutic consequences is doubtful. The aim of this study was to define the frequency of surprising or clinically relevant results in histological reports following adenoidectomy and/or tonsillectomy in children.
From both 1999 and 2004, 200 patients were identified, 10 years old or less, who underwent adenoidectomy/tonsillectomy due to recurrent throat infections or stenotic symptoms of the upper airways or upper swallowing path. The histological reports on these 400 children were evaluated.
At the date of surgery, the median age was 4 years. In 140 children, an adenoidectomy-tonsillectomy was performed, 26 underwent tonsillectomy alone and 234 adenoidectomy alone. No reports with a histological diagnosis other than "lymphatic hyperplasia" or "chronic tonsillitis" were found.
A histological report that is surprising or might influence the further treatment of the patient is rare. From the literature, an unusual diagnosis in children occurs in less than 1 per 1,000. The routine histological examination of adenoidectomy/tonsillectomy tissue cannot nowadays be economically justified. On the other hand, the ethical aspects of the abolition of this inefficient but established method should be discussed. If routine histological examination is abandoned, the surgeon would be responsible for the decision of whether a histological examination is necessary for each individual case (asymmetry of tonsils, extraordinary cervical lymph node status, striking history e.g.).
在儿童腺样体切除术或扁桃体切除术中切除的淋巴组织的组织学检查应被视为一种筛查方法。其目的是检测与“慢性炎症”或“淋巴组织增生”不同的罕见疾病。鉴于出现具有治疗意义的意外结果的频率，这种检查在经济上是否合理尚值得怀疑。本研究的目的是确定儿童腺样体切除术和/或扁桃体切除术后组织学报告中出现意外或临床相关结果的频率。
从1999年和2004年中各选取200例10岁及以下因反复咽喉感染或上呼吸道或上吞咽通道狭窄症状而接受腺样体切除术/扁桃体切除术的患者。对这400名儿童的组织学报告进行评估。
手术时的中位年龄为4岁。140名儿童接受了腺样体扁桃体切除术，26名仅接受了扁桃体切除术，234名仅接受了腺样体切除术。未发现有除“淋巴组织增生”或“慢性扁桃体炎”以外的组织学诊断报告。
令人惊讶或可能影响患者进一步治疗的组织学报告很少见。从文献来看，儿童中出现异常诊断的比例不到千分之一。如今，腺样体切除术/扁桃体切除术组织的常规组织学检查在经济上不合理。另一方面，应讨论废除这种低效但已确立的方法所涉及的伦理问题。如果放弃常规组织学检查，外科医生将负责决定每个病例是否有必要进行组织学检查（如扁桃体不对称、颈部淋巴结异常、病史显著等）。
