Nigro J F, Gresik M V, Fernbach D J
Department of Pediatrics, Baylor College of Medicine, Houston, TX.
J Pediatr. 1990 Mar;116(3):350-4. doi: 10.1016/s0022-3476(05)82819-7.
Because of concerns about the declining autopsy rate, an attempt was made to evaluate the contributions from the postmortem examination in a pediatric population with leukemia. Accordingly, 161 autopsies performed between 1970 and 1985 were reviewed and the diagnoses compared with those listed in the clinical records of the same patients. New diagnoses were grouped into diagnoses of diseases thought to have contributed to the death of the patient, those of diseases thought to have contributed to the morbidity of the patient, those of presumed toxic reactions to drug therapy, and diagnoses of academic interest. The newly diagnosed diseases thought to have contributed to the patient's death either had been totally unsuspected by the clinician or had been suspected but incorrectly diagnosed. The most common revelation was the identification of mycotic infections that were thought by the clinician to have been bacterial in origin. The clinical diagnosis of these kinds of infections progressively improved during the study period. Because the changes in diagnoses and therapy, particularly the increasing use of antimycotic therapy, could be directly attributed to autopsy findings and, more recently, because of the expanding use of more toxic multiagent chemotherapy, we believe that the postmortem examination remains an important procedure, even in clinical situations where much is known about the patient.
由于对尸检率下降的担忧，人们试图评估尸检对白血病儿科患者群体的贡献。因此，对1970年至1985年间进行的161例尸检进行了回顾，并将诊断结果与同一患者临床记录中列出的诊断结果进行比较。新诊断结果分为被认为导致患者死亡的疾病诊断、被认为导致患者发病的疾病诊断、对药物治疗的假定毒性反应诊断以及具有学术意义的诊断。新诊断出的被认为导致患者死亡的疾病，要么临床医生完全没有怀疑过，要么虽有怀疑但诊断错误。最常见的新发现是确定了临床医生认为是细菌性感染的真菌感染。在研究期间，这类感染的临床诊断有了逐步改善。由于诊断和治疗的变化，特别是抗真菌治疗的使用增加，可以直接归因于尸检结果，而且最近由于毒性更强的多药化疗的广泛应用，我们认为尸检仍然是一个重要的程序，即使在对患者情况了解很多的临床情况下也是如此。
