儿童尸检141例病理报告与临床分析

目的 通过对141例儿童尸检病理报告分析,总结尸检病例的主要病理/死因及误诊分析,提高临床医师的诊治水平.方法 回顾性分析我科1986年6月至2006年6月,141例儿童尸检结果,按①疾病分类:按世界卫生组织的国际疾病分类,对每一例的一项主要病理诊断予以分类、统计;②年龄分组:28 d一3岁为婴幼儿组,～7岁为学龄前期组,～14岁为学龄期组;③临床诊断列出多项时,统计时计前三项,若其中有一项与病理诊断一致时,则为基本相符,反之为临床误诊.结果 (1)主要病理诊断/死因前三位是:①按系统分:肿瘤41例(29.1%),呼吸系统25例(17.7%),感染性疾病18例(12.7%);②按疾病分:恶性组织细胞增多症18例、败血症12例、小叶性肺炎11例.(2)前10年首位死因为呼吸系统疾病,后10年则为肿瘤;28 d～3岁尸检95例(67.4%),同时发现少见病;(3)基本相符为90例(63.8%),临床误诊51例(36.2%);误诊情况:间质性肺炎、恶性组织细胞增多症等.结论 对危重患者的诊断应兼顾常见病与少见病;尸检可以检验、证实、修正临床诊断,有助于总结临床诊治经验,但对先天性代谢性疾病要结合尿氨基酸筛查综合分析.

Clinicopathological analysis of 141 pediatric autopsy cases

Objective To summarize the major pathological findings,causes of deaths and reasons for misdiagnosis of 141 autopsy cases and thereby to improve the diagnosis level and reduce misdiagnosis.Method A retrospective analysis of pathological repots and clinical materials of 141 pediatric autopsy cases from June,1986 to June,2006 of our department was performed.Classification was based on ①international classification of diseases of the world Health Organization;②age:cases 28 d-3 years old were defined as infants and young children group,-7 yeas olds were defined as preschool age group,-14years olds were school age group;③when statistics was conducted,the first 3 items of the clinical diagnoses were counted.If one of them was consistent with the pathological diagnosis,it was regarded as basically in accordance with the pathology,if none of the first 3 was consistent with pathological diagnosis,the case was regarded as misdiagnosed.Results (1)The top three major pathological diagnosis and causes of death were:①Classified according to system:41 cases had tumor(29.1%),25 cases had respiratory diseases (17.7%),18 cases had infectious diseases(12.7%);②Classified according to disease:18 cases had malignant histiocytosis,12 cases had sepsis,11 cases had lobular pneumonia.(2)The causes of deaths changed gradually.The top cause of death was respiratory diseases during the former 10 years and was tumor during the latter 10 years;the materials showed that 95 cases were 28 d-3 years old(67.4%),and some rare diseases,such as mediastinal and lung chorionic epithelioma(choriocarcinoma),and pulmonary alveolar proteinosis were found.(3)In 90 cases the clinical diagnosis was basically in accordance with the pathological diagnosis(63.8%)and misdiagnosis was found in 51 cases(36.2%).Conclusion For clinical diagnosis of critically ill patients.both common and rare diseases should be considered.Analysis of autopsy materials could confirm and/or correct clinical diagnosis and is helpful to summarize clinical diagnosis experience.