摘要目的 探讨医疗纠纷死亡病例的特点,尤其是尸体解剖量、医院、科室、年龄及死亡原因分布特点,为完善医疗纠纷尸体解剖工作提供经验.方法 对北京大学医学部病理学系2002年1月1日至2008年9月30日275例医疗纠纷尸体解剖病例进行回顾性分析.结果 2002年1月1日至2008年9月30日,医疗纠纷尸体解剖逐年增加,二三级医院的外科、妇产科及一级医院的门急诊为死亡纠纷好发科室,1岁以内围生期胎儿及幼童死亡病例比其他年龄组死亡病例更易导致纠纷,国际疾病分类表(ICD10)中心血管系统疾病、围生期疾患、外伤或医疗过程附加因素三个大类在纠纷病例死亡原因多于其他大类.绝大多数死亡是疾病自然转归的结果,医疗过失行为与患者死亡存在密切关系的病例只占13.5%(37/275).对冠心病猝死、心肌梗死和病毒性心肌炎等的病理诊断应严格掌握诊断标准.结论 医疗纠纷尸体解剖可以明确死因,保留证据,对解决纠纷至关重要.严谨细致的操作、规范的诊断及死因分析是做好医疗纠纷尸体解剖工作的关键.

abstractsObjective To study the characteristics of autopsies in medical dispute cases, with respect to class of hospitals, clinical units concerned, age of deceased and cause of death. Methods Two hundred and seventy-five autopsies performed on medical dispute cases during the period from January 1, 2002 to September 30, 2008 at the Department of Pathology, Health Science Center, Peking University, China were retrospectively reviewed. Results During the period of study, the number of autopsies performed on medical dispute cases gradually increased. Medical dispute cases happened more often in surgical, obstetric and gynecology departments of grade Ⅱ and Ⅲ hospitals, as well as emergency departments of grade Ⅰ hospitals. Perinatal death in infants of less than 1 year old more frequently caused medical dispute than death occurring in other age groups. According to the International Classification of Diseases (ICD10), disorders of the circulatory system, perinatal illnesses, external injury or iatrogenic conditions represented the major categories of cause of death. In general, the vast majority was due to natural causes and only 13.5% were related to iatrogenic reasons or medical negligence. Pathologic diagnosis of sudden coronary death, myocardial infarction and viral myocarditis should only be made with strict diagnostic criteria. Conclusions Autopsies for medical dispute cases can help to delineate the cause of death and provide evidence for further clarification. Meticulous autopsy techniques, application of strict diagnostic criteria and detailed analysis of cause of death are key steps in achieving a high quality service in this area.