臺灣地區法醫電腦斷層掃描於六歲以下死亡案例之應用

Abstract

本研究旨在探討法醫電腦斷層掃描技術在兒童死亡案件鑑定中的應用性。運用回溯研究方法，分析法醫鑑定的解剖報告及死後電腦斷層掃描影像，對比兩種鑑定方法在不同兒童死亡案例中的優點與限制。 透過332件兒童死亡案例分析，深入瞭解近年來臺灣地區六歲以下兒童死亡案件的趨勢，死亡方式中以自然死亡人數最多，其次是意外死亡及他殺案。一歲以下兒童的自然死亡比例有所提升，而兒童他殺案件的總量在近年顯著下降。案件地域分析顯示，北部地區的案件量顯著減少，而中部地區的案件量則顯著增加。死亡原因方面，「疾病」、「窒息」、「生產相關並發症」、「腦傷」及「猝死」則為兒童前五大死因。經研究結果顯示，法醫電腦斷層掃描對骨骼檢查及嚴重創傷的評估具有高度敏感性，能提供更全面的客觀證據，尤其，對較難解剖的區域或非常規解剖部位提供更完整的視野。此外，肺炎、嗆奶致死和生產相關併發症也是臺灣常見的兒童死亡原因。然而，法醫電腦斷層掃描受到死後空腔間積液累積和肺部水腫變化的影響，肺部影像判讀效果受到限制，死因的研判需要結合法醫解剖的顯微觀察及其他鑑定方法進一步綜合評估。 綜觀兒童死亡案件的法醫鑑定，結合法醫解剖與法醫影像的觀察，可以提供更全面且精確的死亡原因分析，從而提高兒童死亡案件的鑑定品質，為法醫實務帶來實質益處。本研究期望能加深各界對法醫電腦斷層掃描的理解，並在未來法醫實務中更加高效地應用法醫影像技術。

The aim of this study is to explore the applicability of postmortem computed tomography (PMCT) in the investigation of these cases. We retrospectively reviewed autopsy reports and PMCT images, comparing the advantages and limitations of both methods in various child mortality cases. Analysis of 332 child mortality cases, we gained an in-depth understanding of the trends in mortality among children under six years old in Taiwan in recent years. The majority of deaths were due to natural causes, followed by accidental deaths and homicides. The proportion of natural deaths in children under one year old has increased, while the total number of child homicide cases has significantly declined in recent years. Regional analysis indicates a significant decrease in cases in northern Taiwan, while the number of cases in central Taiwan has notably increased. The top five causes of death among children were "disease," "asphyxiation," "birth-related complications," "brain injury," and "sudden death." The study results show that PMCT is highly sensitive in assessing skeletal injuries and severe trauma, providing more comprehensive and objective evidence, particularly in areas that are difficult to dissect or in non-routine autopsy regions. Additionally, pneumonia, milk aspiration, and birth-related complications are common causes of child mortality in Taiwan. However, the effectiveness of PMCT in interpreting lung images is limited by postmortem fluid accumulation in the cavities and pulmonary edema. Determining the cause of death requires the integration of microscopic observation and other forensic examination alongside PMCT. In conclusion, the combined use of forensic autopsy and PMCT in child mortality cases can offer a more comprehensive and accurate analysis of the cause of death, thereby improving the quality of forensic investigations and providing tangible benefits to forensic practice. This study seeks to enhance the understanding of PMCT and to facilitate more efficient application of forensic imaging techniques in future forensic investigations.