经自然腔道内镜手术在尸检中的临床运用初探  

Clinical application of natural orifice transluminal endoscopic surgery in autopsy:a case report

作　　者：陈孝 王志强 石怀银 刘婧 王湛博 周庆 付永和 徐世平 石卉 Chen Xiao;Wang Zhiqiang;Shi Huaiyin;Liu Jing;Wang Zhanbo;Zhou Qing;Fu Yonghe;Xu Shiping;Shi Hui(Department of Geriatrics Gastroenterology,The Second Medical Center&National Clinical Research Center for Geriatric Diseases,Chinese PLA General Hospital,Beijing 100853,China;Department of Pathology,The First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]中国人民解放军总医院第二医学中心消化内科,北京100853 [2]中国人民解放军总医院第一医学中心病理科,北京100853

出　　处：《中国法医学杂志》2024年第5期572-576,583,共6页Chinese Journal of Forensic Medicine

摘　　要：目的 探索经自然腔道内镜手术进行微创尸检可行性。方法 对1例新冠病毒肺炎病死者进行经气管、经食管中段、经食管下段、经胃等四种途径尸体解剖,观察相应部位脏器白光内镜下表现,并获取脏器组织标本,进行常规病理学检查。结果 4条通路均成功到达相应脏器;主气管、支气管和肺叶支气管可见弥漫性充血、粘膜下渗血,左下肺叶支气管内充满暗红色痰液;左肺充血明显。主动脉壁可见4处血栓形成,有斑块破裂。胃黏膜充血、糜烂,活动性溃疡;心脏、肝表面光滑。网膜可见局限性脂膜炎。常规病理显示支气管上皮黏膜慢性炎伴急性炎,并见炎性渗出,部分上皮鳞化;肺组织可见部分肺泡上皮增生,少许纤维素样渗出,肺泡间隔增宽,并见急慢性炎细胞浸润;胃黏膜柱状上皮黏膜慢性炎伴急性炎,并见渗出物及真菌菌团。结论 经自然腔道内镜手术进行尸检可行;新冠病毒可致多系统、多器官损害。Objective To explore the feasibility of minimally invasive autopsy by natural orifice transluminal endoscopic surgery.Methods Autopsy was performed on a deceased patient with COVID-19 via transesophageal,transtrachea,and transgastric natural orifice transluminal endoscopic surgery.The white light endoscopic manifestations of the corresponding organs were observed,and organ tissue specimens were obtained for routine pathological examination.Results All four pathways reached the corresponding organs successfully.Diffuse congestion and submucous bleeding were seen in the trachea,bronchus and bronchus of the pulmonary lobes.The bronchus of the left lower lobe was filled with dark red sputum;the surface of the left lung was congested obviously.Four thrombi and plaque rupture were seen on the aortic wall.The gastric mucosa was congested,eroded,and had active ulcers.The surface of heart and liver was smooth.Small lamellar panniculitis was seen in the omentum.Routine pathology showed chronic inflammation with acute inflammation of the bronchial mucosa and inflammatory exudation,and partial squamous metaplasia of the epithelium.In lung tissue,some alveolar epithelial hyperplasia,a little fibrin-like exudation,widened alveolar septa,and infiltration of acute and chronic inflammatory cells were seen.The columnar epithelial mucosa of the gastric mucosa showed chronic inflammation with acute inflammation and exudates and fungal masses.Conclusion Natural orifice transluminal endoscopic surgery is feasible for autopsy,and covid-19 virus can cause multi-system and multi-organ damage.

关 键 词：经自然腔道内镜手术 经食管自然腔道内镜手术 经胃自然腔道内镜手术 尸检 新冠病毒肺炎 

分 类 号：D919.4[医药卫生—法医学]