Multimodality minimally invasive autopsy-A feasible and accurate approach to post-mortem examination
Multimodality minimally invasive autopsy-A feasible and accurate approach to post-mortem examination
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DOI：
10.1016/j.forsciint.2009.11.019
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发表时间：
2010-02-25
影响因子：
2.2
通讯作者：
Law, Wai Lun
中科院分区：
文献类型：
--
作者：
Fan, Joe K. M.;Tong, Daniel K. H.;Law, Wai Lun
背景：尸检一直是西医的基石。随着尸检率的下降，其次是对死者亲属的负面心理影响，尸检的好处已经被破坏了。微创尸检已被引入，但尚未被广泛采用作为“传统”开放入路的替代方法。这项技术不仅提供了有关死亡原因的信息，而且还尽量减少了对死者造成的毁容。本研究旨在探讨该技术的可行性和准确性。方法：由一名经验丰富的法医病理学家和两名经验丰富的腹腔镜外科医生通过胸腔镜、腹腔镜、腔内或血管内入路对一系列验尸官要求尸检的病例进行检查。这一过程被录像，并根据调查结果作出临时诊断和死亡原因。这些发现随后与完整的尸检相关联。经亲属同意，还进行了一些有限的临床尸检。结果：2007年11月至2008年3月共行微创解剖22例。手术的中位持续时间为78.3±20.7分钟。18例患者行胸腔镜、腹腔镜检查，2例疑似主动脉病变患者行内窥镜动脉镜检查。同时进行了四例有限的临床尸检：其中两例为肺组织的胸腔镜活检，一例为胃病理调查的尸检旁上腔镜检查，另一例为因不明原因的酸中毒死亡的患者进行腹腔镜检查。与全尸相比较，诊断准确率为94.4%，敏感性为90%，特异性为100%，阳性预测值为100%，阴性预测值为88.9%。结论：与常规尸检相比，微创尸检是一种可行的方法，结果准确。在死者的近亲不同意进行常规尸检的情况下，前者可以成为获得更有价值信息的宝贵工具。2009爱思唯尔爱尔兰有限公司版权所有。
Background: Autopsy examination has been the bedrock of western medicine. With the decline in the autopsy rate secondary to the negative psychological impact to the deceased's relatives, the benefits of autopsy have been undermined. Minimally invasive autopsy has been introduced but has not been widely adopted as an alternative to the 'traditional' open approach. This technique not only provides information on the cause of death abut also minimizes the disfigurement induced to the deceased. Our study aims to explore the feasibility and evaluate the accuracy of this technique.Methods: A series of coroner cases ordered for autopsy were examined by a group including an experienced forensic pathologist and two experienced laparoscopic surgeons using thoracoscopic, laparoscopic, endoluminal or endovascular approaches. The procedure was video-recorded and the provisional diagnoses and causes of death were made based on the findings. These findings were subsequently correlated with the full autopsy examination. A few limited clinical post-mortem examinations were also performed with consent from relatives.Results: A total of 22 cases of minimally invasive autopsies were performed from November 2007 to March 2008. The median duration of the procedures was 78.3 +/- 20.7 min. Thoracoscopies and laparoscopies were performed in 18 patients while additional arterioscopic examination with endoscope was performed in two patients with suspected aortic diseases. Four consented limited clinical autopsies were also performed: two of them involved thoracoscopic biopsies of lung tissues, one was a para-mortem upper endoscopy for the investigation of pathology of the stomach and the other one was laparoscopy for a patient, who died of unexplained acidosis. Comparison with full autopsies showed that the accuracy of the diagnosis was 94.4%, the sensitivity was 90%, the specificity was 100%, the positive predictive value was 100% and the negative predictive value was 88.9%.Conclusion: Minimally invasive autopsy is a feasible approach, yielding accurate findings when compared with conventional autopsies. The former can be a valuable tool for obtaining more valuable information in situations when the next-of-kin of the deceased does not consent to a conventional autopsy. (C) 2009 Elsevier Ireland Ltd. All rights reserved.