Rodewald A-K, Bode P, Cathomas G, Moch H
Institut für Pathologie und Molekularpathologie, UniversitätsSpital Zürich, Rämistrasse 100, 8091, Zürich, Schweiz.
Institut für Pathologie, Kantonsspital Baselland, Liestal, Schweiz.
Pathologe. 2017 Sep;38(5):416-421. doi: 10.1007/s00292-017-0323-8.
The number of autopsies has been steadily declining worldwide over the past decades. The reasons for this are diverse. Legislation regarding opposition and consent rules does not appear to have had a significant impact on the autopsy rates. Above all, structural causes and the attitude of the medical profession are the reasons for this decline. The main argument for a high autopsy rate is the identification of diagnostic errors; however, diagnostic discrepancies are relatively independent of the rate of autopsies performed. At the University Hospital (UniversitätsSpital) Zurich it could be shown in a study that from 1972-2002 the frequency of relevant diagnostic discrepancies (classes I and II) decreased from 30% to 7%.
The aim of this article is to present the necessity of a stable autopsy rate and to examine the situation of the autopsy in Switzerland.
For this purpose, the importance of autopsies in the fields of quality assurance of medical diagnostics, cancer statistics, medical research as well as further education of doctors in Switzerland is shown. Efforts are being made by the pathologists to counteract the declining autopsy rates.
Declining autopsy numbers have a significant influence on cancer statistics. The rate of newly discovered tumors in autopsies in Switzerland decreased from 42% in 1980 to 17% in 2010. Pediatric autopsies are an important tool for quality assurance of medical diagnostics in neonatology and pediatrics in Switzerland, but the rate of autopsies carried out is also declining. Postmortem magnetic resonance imaging (MRI) examinations (virtopsy) could increase the acceptance of the parents for an autopsy in the future. Autopsies make an important contribution in research and in documentation of therapy-associated side effects and they are an important component of further education of the upcoming medical generations.
在过去几十年里，全球尸检数量一直在稳步下降。其原因多种多样。关于反对和同意规则的立法似乎并未对尸检率产生重大影响。最重要的是，结构原因和医学专业人员的态度是导致这种下降的原因。支持高尸检率的主要论据是识别诊断错误；然而，诊断差异相对独立于所进行的尸检率。在苏黎世大学医院的一项研究表明，从1972年至2002年，相关诊断差异（I类和II类）的频率从30%降至7%。
本文旨在阐述稳定尸检率的必要性，并审视瑞士的尸检情况。
为此，展示了尸检在瑞士医学诊断质量保证、癌症统计、医学研究以及医生继续教育等领域的重要性。病理学家正在努力应对尸检率下降的问题。
尸检数量的下降对癌症统计有重大影响。瑞士尸检中新发现肿瘤的比例从1980年的42%降至2010年的17%。儿科尸检是瑞士新生儿科和儿科医学诊断质量保证的重要工具，但进行的尸检率也在下降。死后磁共振成像（MRI）检查（虚拟尸检）未来可能会提高家长对尸检的接受度。尸检在研究以及记录治疗相关副作用方面做出了重要贡献，并且是未来医学人才继续教育的重要组成部分。
