老年性白内障患者术后医疗纠纷的原因分析

Analysis of postoperative medical disputes in senile cataract patients

目的分析老年性白内障超声乳化联合人工晶状体(IOL)植入术后发生医疗纠纷的原因。设计回顾性病例系列。研究对象北京同仁医院2012-2016年老年性白内障患者行超声乳化联合IOL植入术后纠纷患者58例。方法对术后纠纷比例、性别、年龄、术眼顺序、投诉主要内容描述及纠纷处理结果进行统计分析。主要指标纠纷比例、纠纷因素。结果 58例患者中51~80岁者50例(86.21%),女性33例(56.90%),双眼均手术者12例(20.69%)。投诉时间在术后4~6个月者41例(70.69%)。角膜水肿、角膜炎致患者术后视物模糊、异物感、磨痛投诉者16例(27.59%),黄斑前膜、黄斑水肿、高度近视致视力不提高或下降者15例(25.86%),玻璃体混浊术后飞蚊加重12例(20.69%),术后IOL下移致重影、眩光、头晕4例(6.90%),术后继发性青光眼3例(5.17%),后囊膜破裂致第一次手术时未植入IOL 1例(1.72%),眼内炎1例(1.72%),术后屈光不正致视近物不清楚1例(1.72%)。结论术后各种视觉不适相关症状及视力不提高是老年性白内障术后纠纷的主要原因,术前应充分与患者沟通及解释。

Objective To analyze the causes of medical disputes after phacoemulsification and intraocular lens（IOL） implantation in senile cataract patients. Design Retrospective case series. Participants 58 cases of senile cataract patients with disputes after phacoemulsification and IOL implantation in Beijing Tongren Hospital from 2012 to 2016. Methods The proportion of postoperative disputes, gender, age, sequence of eyes, main contents of complaints and treatment results were statistically analyzed. Main Outcome Measures Dispute proportion and dispute factors. Result Of the 58 patients, 50 cases（86.21%） were 51~80 years old, 33 cases were female（56.90%） and 12 cases（20.69%） were operated on both eyes. The time of formal complaints to the hospital within 4~6 months after operation was 41 cases（70.69%）. 16 cases（27.59%） were corneal edema, keratitis with symptoms of postoperative visual blurring,foreign body sensation, grinding pain. 15 cases（25.86%） were macular epiretinal membranes, macular edema and high myopia with noincreased or decreased visual acuity. 12 cases（20.69%） were vitreous opacity with postoperative floaters increased. 4 cases（6.90%）were postoperative IOL malposition with symptoms of ghosting, glare and dizziness. 3 cases（5.17%） were postoperative secondary glaucoma. 1 case（1.72%） was without IOL implantation caused by posterior capsule rupture. 1 cases（1.72%） was postoperative endophthalmitis, and 1 cases（1.72%） was lower near vision caused by postoperative ametropia. Conclusion Major reason of postoperative medical disputer in cataract patients is vision-retated symptom and unimprovement of visual acuity, and possiblity of the operative complications should be thoroughly communicated and explained to senile cataract patients before surgery.