Department of General Surgery, Gazi University School of Medicine, Ankara, Turkey.
Turk J Gastroenterol. 2021 Feb;32(2):218-224. doi: 10.5152/tjg.2021.20334.
Selective versus routine histopathological examination after cholecystectomy is still in debate. This study aims to investigate the effect of histopathology results on treatment modality and surgery strategy. The validity of the selective histopathology approach was questioned.
The data of patients undergoing laparoscopic cholecystectomy between January 2009 and December 2019 were retrospectively analyzed. The demographics and histopathology results, whether the operation was emergent or elective, and the reasons for conversion to open surgery were recorded. Malignant and precursor histopathology diagnoses were examined, and their relationship with the surgical strategy was questioned.
A total of 2723 patients were included in the study. Of these patients, 2600 (95.5%) were operated under elective, while 123 (4.5%) were operated under emergency conditions. While the surgery was completed laparoscopically in 2685 (98.6%) patients, it was converted to open surgery in 38 (1.4%) patients. Age, gender, the presence of primary gallbladder cancer, acute cholecystitis, and xanthogranulomatous cholecystitis in histopathological examination were found to be independent predictive factors for conversion to open surgery (P < .05). The rate of primary invasive carcinoma in the series was 0.1%.
Routine histopathological examination of the gallbladder is important for demonstrating a wide spectrum of pathological changes in this organ. Invasive cancer or precursor lesions can be detected even in patients without any macroscopic abnormality. Histopathological examination also plays a role in determining follow-up, further examination, and treatment modality in addition to the diagnosis in these patients.
胆囊切除术后选择性与常规组织病理学检查仍存在争议。本研究旨在探讨组织病理学结果对治疗方式和手术策略的影响。选择性组织病理学方法的有效性受到质疑。
回顾性分析 2009 年 1 月至 2019 年 12 月期间行腹腔镜胆囊切除术的患者数据。记录患者的人口统计学和组织病理学结果、手术是否为急诊、转为开腹手术的原因。检查恶性和前体组织病理学诊断，并探讨其与手术策略的关系。
共纳入 2723 例患者。其中，2600 例（95.5%）患者行择期手术，123 例（4.5%）患者行急诊手术。2685 例（98.6%）患者腹腔镜手术完成，38 例（1.4%）患者转为开腹手术。组织病理学检查中年龄、性别、原发性胆囊癌、急性胆囊炎和黄肉芽肿性胆囊炎的存在被认为是转为开腹手术的独立预测因素（P<.05）。该系列原发性浸润性癌的发生率为 0.1%。
对胆囊进行常规组织病理学检查对于展示该器官广泛的病理变化很重要。即使在没有任何肉眼异常的患者中，也可以检测到浸润性癌或前体病变。组织病理学检查在确定这些患者的随访、进一步检查和治疗方式方面除了诊断之外也发挥着作用。
