Department of Surgery, Academic Medical Centre, Amsterdam, the Netherlands.
Colorectal Dis. 2011 Nov;13(11):1214-21. doi: 10.1111/j.1463-1318.2010.02457.x.
Histopathological examination of the appendix after appendectomy is routinely performed. The object of this systematic review is to determine whether routine histopathological examination of the appendix is justified.
PubMed, EMBASE, Web of Science and the Cochrane library were searched without language restriction up to 1 October 2009. All articles that reported on the incidence of histopathologically proven aberrant appendiceal pathology were included.
Nineteen case series reported the incidence of a benign neoplasm [0.5%, weighted mean (WM)], malignant neoplasm (0.2%, WM) and other pathology (0-14%). Nine articles reported the sensitivity of the intra-operative findings to detect aberrant diagnoses. Parasitic infection was detected in 0-19%, endometriosis in 0% and granulomatosis in 0-11% of cases. Five articles addressed the consequences of aberrant pathology. Most patients with parasite infection, granulomatosis and malignant neoplasms underwent additional investigation or treatment, in contrast to patients with a benign neoplasm.
The incidence of unexpected findings in appendectomy specimens is low and the intra-operative diagnosis alone appears insufficient for identifying unexpected disease. The benefit of histopathology is studied inadequately. From the present available evidence, routine histopathology cannot be judged as useless.
阑尾切除术后常规进行阑尾组织病理学检查。本系统评价旨在确定阑尾组织病理学常规检查是否合理。
无语言限制地检索了 PubMed、EMBASE、Web of Science 和 Cochrane 图书馆，检索截至 2009 年 10 月 1 日。所有报道了经组织病理学证实的阑尾异常病理发生率的病例系列研究均被纳入。
19 项病例系列研究报告了良性肿瘤（0.5%，加权均数[WM]）、恶性肿瘤（0.2%，WM）和其他病变（0-14%）的发生率。9 项研究报告了术中所见对异常诊断的检出率。寄生虫感染的检出率为 0-19%，子宫内膜异位症为 0%，肉芽肿病为 0-11%。5 项研究探讨了异常病理的后果。与良性肿瘤患者相比，寄生虫感染、肉芽肿病和恶性肿瘤患者大多接受了进一步检查或治疗。
阑尾切除标本中意外发现的发生率较低，仅通过术中诊断似乎不足以识别意外疾病。组织病理学的获益研究不足。根据目前的证据，不能判断常规组织病理学检查无用。
