甲状腺手术医疗损害鉴定10例分析
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摘要
目的总结和探讨甲状腺外科手术后出现不良后果的医疗损害司法鉴定案例。方法对南方医科大学司法鉴定中心2011—2016年受理并完成的10例甲状腺外科手术相关医疗损害鉴定案件,从案件概况、医疗过错评定、过错行为与损害后果之间因果关系及原因力大小进行回顾分析。结果 10例案件经鉴定均存在医疗过错行为,且与患者损害后果存在因果关系,按照原因力大小分级,主要因素7例,同等因素2例,次要因素1例。结论甲状腺外科手术治疗各环节均可发生医疗过错行为,因并发症的发生而导致医疗纠纷。在实际鉴定中,应从术前诊断、手术指征、术前准备、手术操作、术后并发症的处理、知情告知等各方面评估诊疗行为,结合患者损害后果客观评定过错参与度。
Objective To summarize and discuss the forensic expertise cases involving medical damages related to thyroid surgeries. Method 10 cases of medical damages related to thyroid surgery in Southern Medical University from 2011 to2016 were collected. The reviewed date included general profiles, medical negligence analysis, casual relationship between negligence and medical damage consequences, and analysis of the degree of medical negligence. Results Medical negligence existed in all 10 cases according to the forensic expertise, and there were casual relationships between negligence and damage consequences. Medical negligence was the main factor that caused damages in 7 cases, the same factor in 2 cases and the secondary factor in one case. Conclusion Thyroid surgery can produce medical disputes in every step of the disease diagnosis and treatment. In the practice of forensic expertise, we should assess medical behaviors from the aspects including pre-operative diagnosis, surgical indication, surgical preparation, surgical technique, complication treatment and medical informed notification, and evaluate the degree of medical negligence objectively combining with the patients' medical consequences.
Objective To summarize and discuss the forensic expertise cases involving medical damages related to thyroid surgeries. Method 10 cases of medical damages related to thyroid surgery in Southern Medical University from 2011 to2016 were collected. The reviewed date included general profiles, medical negligence analysis, casual relationship between negligence and medical damage consequences, and analysis of the degree of medical negligence. Results Medical negligence existed in all 10 cases according to the forensic expertise, and there were casual relationships between negligence and damage consequences. Medical negligence was the main factor that caused damages in 7 cases, the same factor in 2 cases and the secondary factor in one case. Conclusion Thyroid surgery can produce medical disputes in every step of the disease diagnosis and treatment. In the practice of forensic expertise, we should assess medical behaviors from the aspects including pre-operative diagnosis, surgical indication, surgical preparation, surgical technique, complication treatment and medical informed notification, and evaluate the degree of medical negligence objectively combining with the patients' medical consequences.
引文
[1]奚晓明.《中华人民共和国侵权责任法》条文理解与适用[M].北京:人民法院出版社,2010:406-410.
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[9]张纯兵,杜志淳.医疗损害司法鉴定因果关系分析及参与度判定[J].中国司法鉴定,2015(5):100-104.
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[2]夏文涛,朱广友,杨小萍.医疗纠纷的鉴定与防范[M].北京:科学出版社,2015:85-87,208.
[3]葛均波,徐永健.内科学[M].第8版.北京:人民卫生出版社,2013:697-700.
[4]中华医学会内分泌学分会.中国甲状腺疾病诊治指南-甲状腺结节[J].中华内科杂志,2008(10):867-868.
[5]陈孝平,汪建平.外科学[M].第8版.北京:人民卫生出版社,2013:240-243.
[6]吴孟超,吴在德.黄家驷外科学[M].第7版.北京:人民卫生出版社,2008:1130-1135.
[7]中华医学会.临床技术操作规范.普通外科分册[M].北京:人民军医出版社,2010:14-16.
[8]奚晓明.《中华人民共和国侵权责任法》条文理解与适用[M].北京:人民法院出版社,2010:396.
[9]张纯兵,杜志淳.医疗损害司法鉴定因果关系分析及参与度判定[J].中国司法鉴定,2015(5):100-104.
[10]蔡继峰,郭亚东.医疗损害鉴定与防范新进展[M].北京:人民卫生出版社,2016:75-80.