胰腺出血的法医学鉴定(附85例案例分析)

Hemorrhage of Pancreas in Medicolegal Expertise-Retrospective Analysis on 85 Cases

目的：探讨胰腺出血的病理特点与鉴别要点。方法：从性别、年龄、病理特点等方面对四川华西法医学鉴定中心1996～2006年检验的85例胰腺出血案例进行回顾性研究分析。结果：胰腺出血除见于出血性胰腺炎（22例）外,亦可见于其他原因引起的猝死（32例）、机械性损伤（12例）、机械性窒息（3例）、失血性休克（3例）、中毒（11例）、过敏（2例）等。22例出血性胰腺炎均有胰腺实质及间质灶性或片状出血,腺上皮细胞灶性凝固性坏死,脂肪坏死,以嗜中性粒细胞为主的炎细胞浸润;其中18例血清淀粉酶含量明显升高。而63例其他原因所致胰腺出血中除部分中毒案例外无上述改变。结论：诊断出血性胰腺炎需要结合组织病理学检查、实验室生化检测、毒物分析等检验以排除中毒或其他致死原因。

Objective：To study the pathological character and differential diagnosis of hemorrhagic pancreatitis.Methods：The age of death,sex and the pathological changes of hemorrhagic pancreatitis were analyzed according to the anatomical and pathological materials from hemorrhage of pancreas in 85 cases in our college.Results：The obtained data showed that the hemorrhage of pancreas not only existed in hemorrhagic pancreatitis（22 cases）,but also in other sudden deaths（32 cases）,mechanical injury（12 cases）,mechanical asphyxia（3 cases）,hemorrhagic shock（3 cases）,intoxation（11 cases）,hypersensitiveness（2 cases）and so on.There were some pathologic changes including pancreas hemorrhage,gland alveolus necrosis,fat necrosis and neutrophil infiltration in 22 cases of hemorrhagic pancreatitis.The content of serum amylase increased obviously in 18 cases.But these alterations did not exist in the hemorrhage of pancreas induced by some other causes besides intoxation.Conclusion：Identification of the hemorrhagic pancreatitis should adhere to the results of histopathology,laboratory test,toxicological analysis and preclusion of other lethal factors.