- 期刊
Is Routine Pathological Evaluation of Surgical Specimens of Hemorrhoidectomy Necessary?
痔瘡切除術後檢體須常規性的送病理化驗嗎？
摘要
目的 本篇研究主要探討痔瘡切除後檢體常規性的送病理化驗的必要性。病患和方法 本研究採用台北國泰綜合醫院，於2006年1月至2010年12月期間，痔瘡手術的組織病理資料庫。經篩選過後排除那些進行其他肛門手術的病患，例如同時進行肛門廔管切開術的病患。並評估與預期不符的病理結果之發生率。結果 我們發現在917個痔瘡手術中，總共有6個手術中肉眼看為痔瘡的案例最後結果為組織病理異常（占了百分之0.65）。其中2例為局部性的扁平細胞異常（占了百分之0.21），1例為扁平細胞原位癌（占了百分之0.11），1例為尖性濕疣（占了百分之0.11），1例為腺細胞原位癌（占了百分之0.11），以及1例發炎性腸胃道息肉（占了百分之0.11）。這6位病患皆於術後無需接受任何後續處理。結論 痔瘡手術後檢體常規性的送病理化驗，並不是絕對需要。我們建議可以選擇性的對於在術前外觀上有所懷疑的標本進行病理組織檢驗即可。但是在台灣，中華民國醫師法明定所有病人身上取下之手術檢體皆須送病理檢驗。而醫療是否浪費則不是法律問題。
並列摘要
Purpose. The purpose of this study was to evaluate whether routine pathological examination of hemorrhoidectomy specimens is necessary. Patients and Methods. The Taipei Cathay General Hospital histopathologic database between January 2006 and December 2010 was mined with the key word “hemorrhoidectomy”. The histopathologic reports of patients who had received concomitant anal surgery, such as fistulotomy at the same time were excluded. We found that 917 patients had only a preoperative diagnosis of hemorrhoid and received only a hemorrhoidectomy. The incidence of unexpected pathologic findings were analyzed and evaluated. Results. There were 6 histopathologic abnormalities (0.65%) among the 917 hemorrhoidectomy specimens. There were 2 cases of focal mild squamous dysplasia (0.21%), 1 case of squamous cell carcinoma in situ (0.11%), 1 case of condyloma accumulata (0.11%), 1 case of adenocarcinoma in situ (0.11%), and 1 case of inflammatory cloacogenic polyp (0.11%). All 6 patients did not receive further surgical management. Conclusion. Routine histopathologic evaluation of hemorrhoidectomy specimens appears unnecessary and costly from the perspective of a colorectal surgeon, as only 0.65% of specimens harbor occult pathology.We recommend selective histopathologic examination for hemorrhoidectomy specimens that exhibit gross suspicious appearance other than that of hemorrhoids at preoperative examination. However, the law in Taiwan requires that all specimens obtained from patients be sent for histopathologic examination.