109例儿科尸检与临床诊断比较

The comparison between clinical and autopsy diagnosis of 109 dead pediatric cases

目的 通过对 1 0 9例尸解病例的分析 ,探讨死亡病例的临床诊断和病理诊断的相关问题。方法 回顾性分析 8年中 1 0 9例死亡病例尸体解剖报告与临床资料 ,统计前 3位疾病临床诊断的敏感度、特异度及约登指数。结果 8年中总体尸解率为 2 3 6% ( 1 0 9/461 ) ,误诊率为9 2 % ( 1 0 /1 0 9)。其中肺炎为导致 3岁以下小儿死亡的主要疾病 ,血液疾病和肿瘤是引起 3岁以上小儿死亡的主要疾病。所有尸解病例中 ,以肺炎 ( 60例 )和新生儿肺透明膜病 ( 1 2例 )最多 ,所占的比率分别为 5 5 1 %和 1 1 0 % ;肺炎临床诊断的敏感度、特异度和约登指数分别为 95 %、87 7%、0 82 7,新生儿肺透明膜病的临床诊断的敏感度、特异度和约登指数分别为 83 3%、1 0 0 %、0 833。结论 肺炎是导致小儿死亡的重要疾病之一 ,应重视其诊断和治疗 ;尸解有助于临床医师提高对疾病的认识、总结医疗工作的经验。

Objective To determine the relationship of clinical diagnosis and autopsy diagnosis in 109 autopsied dead cases.Methods Retrospective analysis was made of autopsy and clinical data in 109 dead cases.In the first three death-causing diseases in 109 cases with autopsy,the sensitivity,specificity and Youden's index were calculated.Results The total rate of autopsy was 23.6% and the misdiagnosis rate was 9.2%.In the 109 autopsied dead cases during these 8 years,the first common cause for under 3-year-old children was pneumonia and beyond 3-year-old children,acute lymphemia.In these autopsied cases,pneumonia and neonatal pulmonary hyaline membrane disease were the first two common causes for the children's death in our study,the sensitivity?specificity and Youden's index of the clinical diagnosis for pneumonia were 95%,87.7% and 0.827 respectively.The sensitivity,specificity and Youden's indices of clinical diagnosis for neonatal pulmonary hyaline membrane disease were 83.3%,100% and 0.833.Conclusion Pneumonia is one of the most fatal diseases for children.The diagnosis and treatment for pneumonia should be careful and responsible.Autopsy is a useful tool for recognizing real diagnosis and reviewing experience in the process of medicine.