胃切除术医源性损伤和错误的分析

ANALYSES OF MALPRACTICE AND SURGICAL INJURA DURING GASTRECTOMY

胃大部切除术治疗胃十二指肠溃疡为外科最常用手术之一。医源性损伤和错误是医疗工作中值得重视的问题。本文收集1970～1977年海南省15个县医院、部分中心卫生院、农场、矿山医院共26个单位资料。

We collected the data from 26 hospitals in 15 counties in Hainan province from 1970 to 1977. 7390 patients were performed subtotal gastrectomy. Complications and malpractice associated with the opertions directly occurred in 173 cases. Of them 53 were iatrogenic (30.63%).Visceral injury occurred in 12 cases, of them 1 was amputation of pancreas body, 1 omental vascular injury, 2 esophagus iujury, 2 spleen injury, 5 common bile duct injury. Of them 5 died.Of the 9 cases of malposition anastomosis, 6 were stomach distal ileum anastomosis, 2 stomach—middle ileum anastomosis, 1 stomach and transverse colon anastomosis. Of them 5 were diagnosed within 2 weeks and were operated immediately, and cured. 3 were not diagnosed untill 5 weeks to several months. Reconstruction of gastrointestinal tract were performed too, but died of failure.Of the 46 cases of duodenal stump leakage after gastrectomy, 24 were caused by surgical malpractice, accounting for 51.74% (24/46). The technical malpractice were due to the difficulty in suturing the duodenal stump.5 of them died (20%).Of the 13 cases of internal hernia, 10 were associoted with the incorrect treatment for the hiatus of transverse colon mesentery, 3 were having too long afferent loops of pre-colon.