妇产科手术致泌尿系损伤医疗损害法医学鉴定分析

Forensic Analysis of Urinary System Damage after Obstetrics and Gynecology Surgery

目的探讨妇产科手术致泌尿系统损伤医疗损害的类型及因果关系鉴定方法,为该类型医疗损害案件的鉴定提供参考。方法对司法鉴定科学研究院自2013年1月至2020年12月受理的妇产科手术致泌尿系统损伤医疗损害案件,按照原发疾病、手术方式、损害后果及因果关系类型进行统计分析。结果 36例案件中子宫良性疾病13例、子宫恶性肿瘤23例,传统开放手术11例、腹腔镜手术25例,膀胱损伤6例、输尿管损伤30例,医疗过错与损害后果之间无因果关系1例、轻微原因1例、次要原因3例、同等原因9例、主要原因21例、全部原因1例。结论在此类医疗损害案件鉴定过程中,最终因果关系类型的判定与自身疾病、损害后果、医疗过错等均密切相关。通过列举妇产科手术后泌尿系统损伤的典型案例,就因果关系类型的辨析进行了具体的阐述,总结了医疗损害鉴定过程中关于因果关系类型及参与程度评定较为实用的方法,便于鉴定人在实践中借鉴和参考。

Objective The paper is set out to discuss the types of medical damage to urinary system injury caused by obstetrics and gynecology surgery as well as the methods to identify the causality, thus providing guidance for the identification of this type of medical damage cases. Methods The medical damage cases of urinary system injury caused by gynecological surgery accepted by the Academy of Forensic Sciences from January 2013 to December 2020 were statistically analyzed in accordance with the primary disease, the operation method, the damage consequence and the types of causal relationship. Results Among the 36 cases, 13 were benign diseases of the uterus, 23 were malignant tumors of the uterus;11 were traditional open surgery, 25 were laparoscopic surgery;6 were bladder injury, and 30 were ureteral injuries;1 case with no effect between medical error and damage consequences, 1 case of minor cause, 3 cases of secondary cause, 9 cases of the same cause, 21 cases of primary cause, 1 case of complete cause. Conclusion During the identification process of this type of medical damage, the determination of the final causality type is closely related to the own disease, damage consequence, and medical fault. This article lists out some typical cases of urinary tract injuries after obstetrics and gynecology operations, also the paper specifically elaborates the types of causality as well as summarizes the more practical methods for evaluating the types of causality and the degree of participation in the process of medical injury identification, which is convenient for the appraiser to take reference.