【摘要】 目的 分析心臟瓣膜置換術后死亡案例的法醫病理學特點，探討有關瓣膜置換術后死亡案例的法醫病理學鑒定思路及原則。 方法 從手術方式、術前心臟狀況及術中所見、法醫病理檢驗所見、死亡時間、死亡原因等方面，對2008年1月-2010年2月4例心臟瓣膜置換術后死亡案例進行綜合研究分析。 結果 4例均患有風濕性心臟病，且術前心功能較差；3例二尖瓣瓣膜置換術，3例主動脈瓣瓣膜置換術，2例三尖瓣成形術；二尖瓣瓣膜置換術1例平行房間溝的左房縱行切口，1例右心房-房間隔切口，1例右心房-房間隔-左房聯合切口；主動脈瓣瓣膜置換術均行升主動脈根部斜形切口或S狀切口；死亡時間為1例術中，1例術后30 min，1例術后2 d，1例術后8 d；死亡原因為1例心肌炎，1例傳導系統出血，2例失血性休克；1例術前有潛在感染灶。 結論 對有關心臟瓣膜置換術后死亡案例的法醫病理學鑒定時，應在了解患者瓣膜置換術前心臟情況以及手術方式、手術路徑和縫合方法的基礎上，結合法醫病理組織學檢查進行綜合分析。【Abstract】 Objective To analyze the forensic pathological characteristics of those who died after cardiac valve replacement and explore the mentality and principle of documentary evidence of medicolegal expertise. Methods Four death cases after cardiac valve replacement between January 2008 and February 2010 were comprehensively analyzed from various aspects of surgery style, preoperational heart condition, peri-operational observations, results of forensic pathological tests, time of death, and causes of death. Results All cases were rheumatic heart disease and the preoperational heart function was poor. Of the four cases, three had mitral valve replacement (MVR), three had aortic valve replacement (AVR) and two had tricuspid valvuloplasty. Of the three MVR cases, cutting on the left atrium paralleling the interatrial groove was performed in one case, cutting through right atrium and interauricular septum was performed in one case, and cutting left atrium and right atrium through interauricular septum was performed in another case. For all the three AVR cases, cutting on the root of aorta with the shape of diagonal or ’S’ was carried out. One patient died during operation, one died thirty minutes after operation, one died two days after operation and one died eight days after operation. Among them, one died of myocarditis, one died of hemorrhage in the conducting system and two died of hemorrhagic shock. Besides, one patient had potential bacterial infection before surgery. Conclusion For patients who died after cardiac valve replacement, we should acquaintance ourselves with the preoperational heart condition, surgery style, surgical approach and the methods of stitch to make a comprehensive analysis with forensic pathology examination.
