11例肝胆外科非计划再次手术的原因及对策分析

Causes and stratege of unplanned reoperation in hepatobiliary surgery:a report of 11 cases

目的探讨分析非计划再次手术的原因及对策,降低非计划再次手术发生率和提高预防水平。方法对武汉大学人民医院肝胆外科2016年7月至2018年7月非计划再次手术发生的原因和分布情况进行回顾性分析,总结非计划再次手术发生后的应对策略。结果 11例非计划再次手术病人,按病因分类:术后出血3例,切口不愈1例,切口感染1例,胆汁性腹膜炎5例,T管滑脱1例。其中10例病人好转出院(90.9%),1例因感染性休克死亡(9.1%)。非计划再次手术病人平均住院日相比普通病人明显延长,进而导致住院费用增加。结论肝胆外科非计划再次手术的发生往往是多方面、复杂的因素导致的,主要由术后并发症及医源性损伤导致。加强医疗质量监控,规范精细化手术操作,避免医源性损伤,缩短手术时间,减少术中出血,提高医务人员的责任心、手术的经验技巧,可降低非计划再次手术发生率,从而减轻病人痛苦,提高医疗质量和水平。

Objective To analyze the causes and countermeasures of unplanned reoperation,induce the occurrence of upplanned reoperation and improve the prevention level.Methods The causes and distribution of unplanned reoperations from July 2016 to July 2018 in Department of Hepatobiliary Surgery,Wuhan University Renmin Hospital were analyzed.The treatment was reviewed and the coping strategies after unplanned reoperation were summarized.Results Eleven patients with unplanned reoperation were classified according to the etiology.There were 3 cases of postoperative hemorrhage,1 case of incision un-healing,1 case of incision infection,5 cases of biliary peritonitis,and 1 case of T tube slip.Ten patients were discharged from hospital(90.9%).One patient died of septic shock(9.1%).The average hospital stay was significantly prolonged,and the hospitalization costs significantly increased in the patients who were not scheduled for reoperation.Conclusions The unplanned reoperation in hepatobiliary surgery is often caused by complicated factors,mainly caused by postoperative complications and iatrogenic injury.Strengthening medical quality monitoring,standardizing surgical operations,avoiding iatrogenic injury,shortening operation time,and reducing intraoperative bleeding,improving the sense of responsibility of medical staff and the experience and skills of surgery can reduce the incidence of unplanned reoperations,thereby reducing patient suffering and improving the quality and level of medical care.