Safaan Tamer, Bashah Moataz, El Ansari Walid, Karam Mohsen
Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar.
Department of Bariatric Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar.
Obes Surg. 2017 Jul;27(7):1741-1749. doi: 10.1007/s11695-016-2525-1.
Laparoscopic sleeve gastrectomy (LSG) is a common surgical therapeutic option for obese patients, with debate about the value of routine histopathologic examination of LSG specimens. We assessed the following: prevalence of different histopathologic changes in LSG specimens, risk factors associated with premalignant and with frequent histopathologic changes, and whether routine histopathologic examination is warranted for LSG patients with nonsignificant clinical history.
Retrospective review of records of all LSG patients operated upon at Hamad General Hospital, Qatar (February 2011-July 2014, n = 1555), was conducted. Risk factors (age, BMI, gender, and Helicobacter pylori) were assessed in relation to specific abnormal histopathologic changes.
Mean age and BMI of our sample were 35.5 years and 46.8, respectively. Females comprised 69.7% of the sample. Normal histopathologic specimens comprised 52% of the sample. The most common histopathologic changes were chronic inactive gastritis (33%), chronic active gastritis (6.8%), follicular gastritis (2.7%), and lymphoid aggregates (2.2%). We observed rare histopathology in 3.3% of the sample [e.g., intestinal metaplasia and gastrointestinal stromal tumor (GIST)]. Older age was associated with GIST and intestinal metaplasia (P = 0.001 for both). Females were associated with chronic active gastritis (P = 0.003). H. pylori infection was associated with follicular gastritis, lymphoid aggregates, GIST, intestinal metaplasia, and chronic active gastritis (P < 0.001 for each).
Older age, H. pylori, and female gender are risk factors for several abnormal histopathologic changes. Histopathologic examination of LSG specimens might harbor significant findings; however, routine histopathologic examination of all LSG specimens, particularly in the absence of suggestive clinical symptoms, is questionable. The association between female gender and chronic active gastritis; and the association between H. pylori infection and GIST are both novel findings that have not been previously reported in the published literature.
腹腔镜袖状胃切除术（LSG）是肥胖患者常见的手术治疗选择，对于LSG标本的常规组织病理学检查的价值存在争议。我们评估了以下内容：LSG标本中不同组织病理学变化的发生率、与癌前病变和频繁组织病理学变化相关的危险因素，以及对于临床病史无明显异常的LSG患者是否有必要进行常规组织病理学检查。
对卡塔尔哈马德总医院2011年2月至2014年7月接受LSG手术的所有患者（n = 1555）的记录进行回顾性分析。评估了与特定异常组织病理学变化相关的危险因素（年龄、体重指数、性别和幽门螺杆菌）。
我们样本的平均年龄和体重指数分别为35.5岁和46.8。女性占样本的69.7%。正常组织病理学标本占样本的52%。最常见的组织病理学变化为慢性非活动性胃炎（33%）、慢性活动性胃炎（6.8%）、滤泡性胃炎（2.7%）和淋巴样聚集（2.2%）。我们在3.3%的样本中观察到罕见的组织病理学变化[如肠化生和胃肠道间质瘤（GIST）]。年龄较大与GIST和肠化生相关（两者P均= 0.001）。女性与慢性活动性胃炎相关（P = 0.003）。幽门螺杆菌感染与滤泡性胃炎、淋巴样聚集、GIST、肠化生和慢性活动性胃炎相关（每项P < 0.001）。
年龄较大、幽门螺杆菌感染和女性是几种异常组织病理学变化的危险因素。LSG标本的组织病理学检查可能会有重要发现；然而，对所有LSG标本进行常规组织病理学检查，尤其是在没有提示性临床症状的情况下，是值得怀疑的。女性与慢性活动性胃炎之间的关联；以及幽门螺杆菌感染与GIST之间的关联都是新发现，此前在已发表的文献中尚未报道。
