临床病理尸检与法医病理尸检的对比分析

Comparative Analysis and Introspection on Clinical Pathological Autopsy and Forensic Pathological Autopsy

目的分析当前形势下临床病理尸检及法医病理尸检的现状，探讨其存在的原因、不良后果及相应的对策。方法收集宁波卫生职业技术学院1961年到2007年所接受的1024例尸体解剖资料，以10年为单位分析其来源构成。结果临床病理解剖的尸检率在急剧下降：1961～1970年间的构成比（78．3％）高于其总水平（x^2=3．899，P=0．048），而2001年以后显著下降（构成比13．0％），明显低于其总水平（X^2=49．401，P〈0．001）；与此相反，医疗争议委托的尸检量迅速增多，尤以2001年以后显著，其构成比由1961～1970年间的8．0％上升到2001年以后的68．4％（与其总水平比较分别为x^2=9．392，P=0．002；x^2=78．805，P〈0．001）。结论临床尸检率下降的原因是多方面、复杂的，临床尸检率下降不利于医学科学的发展；在医疗纠纷尸检增多的同时，应重视和充分利用医疗纠纷尸检的资源，还应提倡积极开展临床尸检工作和临床病理讨论，以提高临床诊疗水平。

Objective To analyze the current status of clinical pathological autopsy and forensic pathological autopsy,and to discuss the reasons of the changes, possible bad consequence and corresponding countermeasures. Methods Total 1024 autopsy cases which were collected from 1961 to 2007 were retrospectively reviewed and the statistics analysis was performed in the source constitution with 10-year period. Results The ratio of clinical pathological autopsy fell sharply. It was higher than its total level with the ratio 78.3% in 1961 -1970 （x2 = 3. 899, P = 0.048 ）, but after 2001 it declined obviously and was obviously lower than its total level with the ratio 13.0% （x2 = 49. 401, P 〈 0. 001 ）. On the contrary, the number of forensic pathological autopsies which were from medical dispute was increasing rapidly, especially after 2001. Its ratio was 8.0% in 1961 - 1970 and was 68.4% after 2001. Compared with its total level,the X2 value was 9.392 and 78. 805 with P value O. 002 and 〈0. 001 ,respec- tively. Conclusion The reasons for the declining in clinical pathological autopsy are various and complicated. If this trend continues, the development of medical science will be inhibited. At present, the medical disputes autopsies are increasing, but in the same time we should attach importance to and make full use of the resource of medical disputes autopsies, and make positive ef- forts to promote clinical pathology autopsy and clinical pathology discussion, thus to improve the level in clinical diagnosis and treatment.