Department of Surgery, Máxima Medical Center, PO Box 7777, 5500 MB, Veldhoven, The Netherlands.
Department of Pathology, PAMM Laboratory for Pathology and Medical Microbiology, Eindhoven, The Netherlands.
J Gastrointest Surg. 2019 Jun;23(6):1130-1134. doi: 10.1007/s11605-018-3921-8. Epub 2018 Aug 21.
Routine histopathologic gallbladder examination after cholecystectomy has been a point of discussion. The aim of this study was to evaluate the macroscopic examination by the surgeon in relation to the final histology.
A prospective study was conducted to investigate the practice of macroscopic gallbladder examination by a surgeon compared to routine histopathology by a pathologist. All consecutive cholecystectomies were included between November 2009 and February 2011.
A total of 319 consecutive cholecystectomies were performed. Of all macroscopic examinations, the surgeon identified 62 gallbladders with macroscopic abnormalities, ranging from polyps to wall thickening or ulcers. In 55 (17.2%) cases, the surgeon judged that further examination of the specimen by the pathologist could possibly lead to additional and relevant findings. There was a strong agreement between the surgeon and the pathologist concerning the macroscopic examination (κappa = 0.822). The surgeon and the pathologist had disagreement on the macroscopic examination of 18 gallbladders, without clinical consequences for the patient.
The present prospective study shows that the surgeon should be able to select those gallbladders needing a microscopic gallbladder examination. Potentially, about 80% of this kind of routine histology can be reduced.
胆囊切除术后常规进行组织病理学胆囊检查一直存在争议。本研究旨在评估外科医生的大体检查与最终组织学的关系。
前瞻性研究调查了外科医生的大体胆囊检查与病理医生常规组织病理学检查的实践情况。所有连续的胆囊切除术均在 2009 年 11 月至 2011 年 2 月期间进行。
共进行了 319 例连续的胆囊切除术。在所有的大体检查中，外科医生发现 62 例胆囊有大体异常，从息肉到壁增厚或溃疡不等。在 55 例（17.2%）中，外科医生判断病理医生进一步检查标本可能会有额外的相关发现。外科医生和病理医生在大体检查方面有很强的一致性（kappa = 0.822）。外科医生和病理医生在 18 例胆囊的大体检查上存在分歧，但对患者没有临床影响。
本前瞻性研究表明，外科医生应该能够选择需要显微镜下胆囊检查的胆囊。这种常规组织学检查的潜在比例可能会减少约 80%。
