410例腹腔镜胆囊切除术损害案件的医疗责任影响因素分析  

Analysis of influencing factors of medical liability for 410 cases of damages in laparoscopic cholecystectomy

作　　者：温红霞 李刚 曹廷龙 董巧儿 万辉 WEN Hongxia;LI Gang;CAO Tinglong;DONG Qiaoer;WAN Hui(The Teaching and Research Support Center,Naval Medical University,Shanghai 200433,China;The First Affiliated Hospital of Naval Medical University,Shanghai 200433,China)

机构地区：[1]海军军医大学教研保障中心,上海200433 [2]海军军医大学第一附属医院,上海200433

出　　处：《卫生软科学》2024年第2期60-64,共5页Soft Science of Health

基　　金：海军军医大学第一附属医院-利用三维重建模型提高外科研究生肝胆胰手术能力的临床教学研究(CHPY2021A07)。

摘　　要：[目的]分析在腹腔镜胆囊切除术涉及医疗损害的案件中影响医疗责任判定的因素,为减少此类手术发生医疗损害提供参考及建议。[方法]在中国裁判文书网中,以“腹腔镜胆囊切除术”为关键词,“医疗损害”为案件名称,“判决书”为文书类型进行检索。以医法汇发布的医方败诉原因作为影响因素的分类依据,采用二元Logistic回归对因素进行分析。[结果]共纳入410例腹腔镜胆囊切除术涉及医疗损害的判决案件,梳理出10类影响因素。其中,术前评估不全、违反诊疗规范、未尽注意义务的差异有统计学意义(P<0.05)。违反诊疗规范(OR=3.374)、未尽注意义务(OR=2.781)是增大医疗损害责任的危险因素,术前评估不全是保护因素(OR=0.280)。[结论]术前评估不全、违反诊疗规范、未尽注意义务是腹腔镜胆囊切除术损害责任的影响因素,若损害案件中存在违反诊疗规范和未尽注意义务可致较高的损害责任。医务人员在实施腹腔镜胆囊切除术时,可通过严格遵守诊疗规范、认真履行注意义务、术前开展全面评估来减轻损害责任。Objective To analyze the factors affecting the judgment of medical liability for damage cases in laparoscopic cholecystectomy,and to provide suggestions for reducing the damages in such operations.Methods In the China Judgements Online,with laparoscopic cholecystectomy as the key word,medical damage as the name of the case,and judgment as the type of document,the search was carried out.The reasons for losing lawsuits of hospitals issued by Yi Fa Hui website were taken as the classification basis of the influencing factors.The binary logistic regression was used to analyze the factors.Results Ten influencing factors were sorted out through 410 cases of laparoscopic cholecystectomy involving medical damages.Among them,the differences of incomplete preoperative evaluation,violation of diagnosis and treatment norms,and lack of duty of care were statistically significant(P<0.05).Violation of diagnosis and treatment norms(OR=3.374),and lack of the duty of care(OR=2.781)were risk factors of increasing the liability for medical damage;incomplete preoperative assessment was a protective factor(OR=0.280).Conclusions Incomplete preoperative evaluation,violation of diagnosis and treatment norms,and lack of duty of care are the influencing factors of the liability for damages in laparoscopic cholecystectomy.Violation of diagnosis and treatment norms and lack of duty of care can lead to higher liability for damage.Liability for damage can be reduced by abiding by the diagnosis and treatment norms,fulfilling the duty of care,and carrying out the comprehensive evaluation before operation during laparoscopic cholecystectomy.

关 键 词：腹腔镜胆囊切除手术 医疗损害 医疗责任 医疗过错 

分 类 号：R197.32[医药卫生—卫生事业管理] R61[医药卫生—公共卫生与预防医学]