车祸伤后医疗纠纷的法医学鉴定

Forensic Expertise and Study of Car Accidents Involved in Medical Dispute

目的对1例车祸伤后医疗纠纷的法医学鉴定相关问题进行讨论分析.方法对该病例的相关理论进行回顾性分析,对案例进行详细认真的尸体检验与死因鉴定.结果本案尸检及病理组织学检查结果证实伤者因交通事故致十二指肠断裂伤,经R-Y吻合手术后有肠段吻合口瘘形成,导致机体弥漫性化脓性腹膜炎、机体极度营养不良继发多器官感染,最终导致多器官功能衰竭而死亡.结论在整个病程中因R-Y吻合口瘘致多器官系统的功能衰竭并非各自独立,而是互相影响、互相作用甚至互为因果,这在本例已充分体现.在对道路交通事故损伤后有医疗行为参与的致死原因分析案例的法医学鉴定中,不仅应注意判定相互因果关系和医疗过程的参与度,还应进行原发性损伤与医源性损伤的鉴别.

Objective To identify and study a case of traffic accident injury,which involved in a medical dispute during the medical treatment after the injury.Methods A retrospective analysis of the case was included according to the relevant data and the details of an autopsy were analyzed so as to identify the cause of death.Results Autopsy and histopathological examination confirmed that the traffic injury was an underlying cause of death.The postmortem examination showed that the traffic accident led to the duodenal rupture and the R-Y anastomosis fistula on intestinal segment,led to a diffuse purulent peritonitis.The multiple organ infection eventually led to the multiple organ failure.In one word,traffic injury on duodenum was the underlying cause of death whereas the diffuse purulent peritonitis was the direct cause of death and the multiple system organ failure is the mechanism of death.Conclusion In road traffic accident involving medical dispute,we should not only pay attention to the cause of death,but to distinguish the primary injury with the iatrogenic damage.