147例儿童临床诊断与尸检病理诊断的对比性研究

A comparative study of clinical diagnoses and autopsy pathologic diagnoses in 147 pediatric autopsy cases

目的:比较147例儿童临床诊断与尸检病理诊断异同。方法:回顾分析重庆医科大学法医学教研室1988～2008年,147例涉及到医疗纠纷的儿童尸体解剖案例,统计内容主要包括性别、年龄、医院等级、临床诊断、尸检诊断、就诊时间、死亡原因。结果:临床诊断与尸检诊断完全一致的有45例(占30.6%),临床诊断与尸检诊断不一致的有32例(21.8%),临床诊断与尸检诊断部分不一致的有42例(28.6%),诊断不明的有28例(19%)。主要致死疾病是肺炎,误诊率最高的是心血管系统和神经系统,疾病中心肌炎、结核与伤寒的误诊率较高。结论:尸检是处理医疗纠纷客观的证据之一,也是推动医学发展,提高临床诊治水平的重要手段之一,应积极提高尸检率。

Objective：To compare the difference between clinical diagnosis and forensic pathologic diagnosis in 147 pediatric autopsy cases.Methods：147 cases of pediatric death related to medical tangle,were autopsied by the department of forensic medicine of Chongqing medical university during 1988-2008.Statistics data including sex,age,the rank of hospital,clinical diagnosis,autopsy diagnosis,treatment time,and distribution of disease were analyzed.Results：The cases of complete coincidence between clinical diagnosis and forensic pathologic diagnosis were 45（30.6%）,the cases of discordant coincidence were 32（21.8%）,the cases of part coincidence were 42（28.6%）,and there were 28 cases（19%）of undefinite diagnoses.The main causes of death was pneumonia.The highest misdiagnosis rate were the disease of cardiovascular system and nervous system,meanwhile the most frequently misdiagnosed diseases were myocarditis,tuberculosis and typhoid fever.Conclusion：Autopsy is one of the most objective evidence for medical tangle.It is also an important means to promote medical advances and improve the levels of clinical diagnosis and treatment.The autopsy will be improved actively.