Morgan A, Dawson P M, Smith J J
Dept of Colorectal Surgery, West Middlesex University Hospital, UK.
Surgeon. 2006 Apr;4(2):75-7. doi: 10.1016/s1479-666x(06)80033-8.
Left-sided colonic resections are often anastomosed by the use of the circular stapling gun. Most surgeons routinely submit the resulting set of 'doughnuts' for histological examination.
The aim of this study is to question the need for this practice by providing our own experience of the impact of 'doughnut' submission on patient management.
Patients who had undergone a stapled anastomosis for colorectal cancer resection (1998-2004) were identified from the department cancer database and clinical records and histopathological reports were reviewed for all cases.
From a consecutive series of 100 sets of doughnuts only two showed histological abnormality (inflammatory change and a metaplastic polyp). Three patients had local recurrence over the follow-up period: 12, 14 and 36 months after surgery. Histological review of the 'doughnuts' in these patients did not show any abnormality. None of the above findings had any influence on subsequent management.
Histological examination of the 'doughnuts' has a considerable impact in terms of time and resource use. This study has shown no benefit in performing routine histological examination of the 'doughnuts'.
左半结肠切除术常使用圆形吻合器进行吻合。大多数外科医生会常规将切下的“标本环”送检做组织学检查。
本研究旨在通过分享我们自身关于“标本环”送检对患者管理影响的经验，对这种做法的必要性提出质疑。
从科室癌症数据库中识别出1998年至2004年间接受结直肠癌切除吻合器吻合术的患者，并查阅所有病例的临床记录和组织病理学报告。
在连续的100个标本环中，只有两个显示组织学异常（炎症改变和化生息肉）。3例患者在随访期间出现局部复发，分别在术后12个月、14个月和36个月。对这些患者的“标本环”进行组织学检查未发现任何异常。上述发现均未对后续管理产生任何影响。
“标本环”的组织学检查在时间和资源利用方面有相当大的影响。本研究表明，对“标本环”进行常规组织学检查并无益处。
