The use of autopsies in medicine has been declining. The COVID-19 pandemic has documented and rejuvenated the importance of autopsies as a tool of modern medicine. In this review, we discuss the various autopsy techniques, the applicability of modern analytical methods to understand the pathophysiology of COVID-19, the major pathological organ findings, limitations or current studies, and open questions. This article summarizes published literature and the consented experience of the nationwide network of clinical, neuro-, and forensic pathologists from 27 German autopsy centers with more than 1200 COVID-19 autopsies. The autopsy tissues revealed that SARS-CoV-2 can be found in virtually all human organs and tissues, and the majority of cells. Autopsies have revealed the organ and tissue tropism of SARS-CoV-2, and the morphological features of COVID-19. This is characterized by diffuse alveolar damage, combined with angiocentric disease, which in turn is characterized by endothelial dysfunction, vascular inflammation, (micro-) thrombosis, vasoconstriction, and intussusceptive angiogenesis. These findings explained the increased pulmonary resistance in COVID-19 and supported the recommendations for antithrombotic treatment in COVID-19. In contrast, in extra-respiratory organs, pathological changes are often nonspecific and unclear to which extent these changes are due to direct infection vs. indirect/secondary mechanisms of organ injury, or a combination thereof. Ongoing research using autopsies aims at answering questions on disease mechanisms, e.g., focusing on variants of concern, and future challenges, such as post-COVID conditions. Autopsies are an invaluable tool in medicine and national and international interdisciplinary collaborative autopsy-based research initiatives are essential.

尸检在医学中的使用一直在下降。COVID-19 大流行已经证明并重申了尸检作为现代医学工具的重要性。在这篇综述中，我们讨论了各种尸检技术、现代分析方法在了解 COVID-19 的病理生理学方面的适用性、主要的病理器官发现、局限性或当前研究，以及未解决的问题。本文总结了已发表的文献以及来自 27 个德国尸检中心的全国临床、神经和法医病理学家网络的同意经验，这些中心对 1200 多例 COVID-19 尸检进行了尸检。尸检组织显示，SARS-CoV-2 几乎可以在所有人体器官和组织以及大多数细胞中找到。尸检揭示了 SARS-CoV-2 的器官和组织嗜性，和 COVID-19 的形态特征。其特点是弥漫性肺泡损伤，并伴有血管中心性疾病，其特点是内皮功能障碍、血管炎症、（微）血栓形成、血管收缩和肠套叠性血管生成。这些发现解释了 COVID-19 中肺抵抗力的增加，并支持了 COVID-19 中抗血栓治疗的建议。相反，在呼吸外器官中，病理变化通常是非特异性的，并且不清楚这些变化在多大程度上是由于直接感染与器官损伤的间接/继发机制或其组合引起的。正在进行的使用尸检的研究旨在回答有关疾病机制的问题，例如，关注关注的变体，以及未来的挑战，例如 COVID 后的情况。