腹腔镜胆囊切除术中胆道损伤后主刀医师精神创伤的调查研究  

A survey study on major surgeon′s mental trauma caused by iatrogenic biliary injury during laparoscopic cholecystectomy

作　　者：沈开铖 杨田 戴海粟 苏星星 杨宜恃 张城城 别平 陈志宇 Shen Kaicheng;Yang Tian;Dai Haisu;Su Xingxing;Yang Yishi;Zhang Chengcheng;Bie Ping;Chen Zhiyu(Department of Hepatobiliary Surgery,the First Hospital Affiliated to Army Medical University,Chongqing 400038,China;Department of Hepatobiliary Surgery,Eastern Hepatobiliary Surgery Hospital,Navy Medical University,Shanghai 200438,China;Department of Hepatobiliary Surgery,the Third Affiliated Hospital of Chongqing Medical University,Chongqing 401120,China)

机构地区：[1]陆军军医大学第一附属医院肝胆外科,重庆400038 [2]海军军医大学附属东方肝胆外科医院肝胆外科,上海200438 [3]重庆医科大学第三附属医院肝胆外科,重庆401120

出　　处：《中华消化外科杂志》2020年第5期511-518,共8页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金(81874211);陆军军医大学第一附属医院院管基金(2018XLC2007)。

摘　　要：目的:调查全国范围内腹腔镜胆囊切除术(LC)中胆道损伤后主刀医师精神创伤的情况并探讨其影响因素。方法:采用回顾性横断面调查研究方法。2018年12月1日至2019年1月1日,以中国医师协会外科医师分会和中华医学会外科学分会注册登记的外科医师为调查对象,设计《LC胆道损伤对主刀医师是否造成心理影响及其相关因素的调查》问卷进行调查研究。问卷通过微信方式发放,软件平台为问卷星。观察指标:(1)问卷调查结果。(2)LC致医源性胆道损伤(IBI)后主刀医师发生严重精神创伤的影响因素分析。正态分布的计量资料以±s表示,计数资料以绝对数或百分比表示。单因素分析采用χ^2检验。将单因素分析中P<0.10因素纳入多因素分析,多因素分析采用Logistic回归模型。结果:(1)问卷调查结果。共收回完整问卷606份。①主刀医师基本信息:606位主刀医师中,男596例,女10例;年龄为(41±7)岁,年龄范围为18~62岁。59.24%(359/606)主刀医师来自非教学医院,64.03%(388/606)主刀医师在初级、中级职称时发生印象最深刻的一次LC致IBI,76.24%(462/606)主刀医师第1次发生LC致IBI时印象最深刻,69.80%(423/606)主刀医师认为在术中仔细操作可以避免IBI。②患者相关信息:主刀医师发生印象最深刻一次LC致IBI患者中,女400例,男206例;<35岁、35~65岁、>65岁患者的比例分别为9.57%(58/606)、65.51%(397/606)、24.92%(151/606)。③IBI相关信息:57.43%(348/606)主刀医师发生LC致IBI时能及时获得高年资医师帮助。78.88%(478/606)主刀医师邀请更高年资医师参与初次修复手术。主刀医师发生印象最深刻一次LC致IBI时,66.83%(405/606)IBI初次修复手术在LC术中完成,11.06%(67/606)IBI初次修复手术在术后3 d内完成,22.11%(134/606)IBI初次修复手术在术后3 d后完成。主要修复方式中,局部修复、胆管对端吻合、胆肠吻合的比例分别为24.92%(151/606)、30.20%(183/606)�Objective:To conduct a survey on major surgeon′s mental trauma caused by iatrogenic biliary injury(IBI)during laparoscopic cholecystectomy(LC),and explore its influencing factors.Methods:The retrospective cross-sectional survey was conducted.Surgeons who have registered in Chinese College of Surgeons of Chinese Medical Doctor Association and Chinese Surgical Society of Chinese Medical Association were recruited to participate as respondents between December 1,2018 and January 1,2019.The survey was conducted by the questionnaires of influencing factors for surgeon′s mental trauma caused by IBI during LC.The questionnaires were distributed to participants via WeChat on the Wenjuanxin platform.Observation indicators:(1)results of questionnaire survey;(2)analysis of influencing factors for severe mental trauma of major surgeons caused by IBI during LC.Measurement data with normal distribution were expressed as Mean±SD,and count data were expressed as absolute numbers or percentages.The chi-square test was used for univariate analysis.Factors with P<0.10 in the univariate analysis were included in multivariate analysis,and Logistic regression model was used for multivariate analysis.Results:(1)Results of questionnaire survey.A total of 606 questionnaires were retrieved.①Basic information of major surgeons:of the 606 major surgeons,there were 596 males and 10 females,aged(41±7)years,with a range from 18 to 62 years.Of the 606 major surgeons,59.24%(359/606)came from non-teaching hospitals,and 64.03%(388/606)encounted the most impressive case of IBI during LC when they were in the primary or intermediate professional title.For 76.24%(462/606)of the major surgeons,the first case of IBI during LC was the most impressive case,and 69.80%(423/606)believed that careful operation during LC could avoid IBI.②Patient information:of the patients with the most impressive IBI during LC in each major surgeon′s memory,there were 400 females and 206 males.The proportion of patients younger than 35 years old,in 35-65 years ol

关 键 词：医源性胆道损伤 腹腔镜胆囊切除术 医师心理健康 精神创伤 外科医师 

分 类 号：R657.4[医药卫生—外科学]