腹部外科多次手术影响因素分析(附162例报告)

Influential factors of multiple operations in abdominal surgery: A report of 162 cases

目的探讨腹部外科常见多次手术的影响因素。方法回顾性分析1998年1月至2012年12月哈尔滨医科大学附属第一医院普外科收治的162例多次(≥3次)腹部手术病人的临床资料。结果多次腹部手术病人的手术部位以胆总管、胆囊居多(27.2%),其次为结直肠(19.8%)、胃(15.4%)、阑尾(11.7%)、胰腺(9.9%)及肝脏(7.4%)。在多次手术病人中,实施首次手术的医生职称以副主任医师居多(48.2%),其次为主任医师(26.5%)和主治医师(25.3%)。由外院转入本院行治愈性手病人占82.10%。多次手术以择期手术(64.8%)为主。医源性因素(85.8%)是多次手术的主要原因。多次手术病人的治愈率可达67.3%。产生医疗纠纷比例为69.1%。结论(1)导致外科病人多次手术的原因中存在医源性因素。(2)强化基础知识,遵循基本原则,加强责任心及人文关怀以及加强对医师的专科化重点培养,是预防腹部外科多次手术的重点。

Objective To investigate the influential factors of multiple operations in abdominal surgery. Methods The clinical data of 162 cases of multiple operations（more than 3 times） performed in Department of General Surgery,First Affiliated Hospital of Harbin Medical University between January 1998 and December 2012 were analyzed retrospectively. Results Bile duct and gallbladder diseases ranked the first in multiple operations（27.16%）,followed by colon and rectum（19.75%）, stomach（15.43%）, appendix（11.73%）, pancreas（9.88%） and liver（7.41%）. Multiple operations were performed mainly by associate chief surgeons（48.15%）,secondly by chief surgeons（26.54%）,only25.31% by attending doctors. The first- or second-operations performed in other hospitals account for 82.1%. Selective operations（64.81%）were still the majority of multiple operations. Iatrogenic factors were the main reasons（85.80%）.The cure rate could achieve 67.28%. The incidence of medical dispute was 69.14%. Conclusion Iatrogenic factors cause the complicated disease to some extent. Enhancing basic knowledge, following basic principle and strengthening responsibility, humanistic care and specialized training for surgeons,are critical to prevent multiple operations in abdominal surgery.