This type of surgery must be done with caution!
Event Review
29 The patient, Ms. Zhang, was admitted to a provincial hospital of the defendant because of “menopause for 37 days and a small amount of vaginal bleeding for 2 days“. The hospital performed “Laparoscopic intestinal adhesion release + left fallopian tube fenestration and embryo retrieval“, and postoperative human chorionic gonadotropin Hormone (HCG)decreased poorly, and the hospital considered persistent ectopic pregnancy based on the chief complaint, clinical symptoms and signs, and auxiliary examination results. One week later, “Laparoscopic left salpingectomy+right tubal ligation+right tubal cystectomy“, the patient A total of 13 days of hospitalization. After identification, the patient was rated as 9th grade disability after the left salpingectomy, and filed a lawsuit to the court, claimed to the hospital for 21 Ten thousand.
Identification
The forensic opinion stated that: the medical prescription “dark red contents were seen after incision of the left fallopian tube, and the contents of the fallopian tube were taken out with large spoon forceps”, but butno such contents were found. Carefully check the integrity of the embryonic tissue in the extract, and conduct a detailed investigation of the possible residual villus tissue.. Meanwhile, pathological examination revealed no clear placental villi. Therefore, the existing materialscannot prove the existence of intraoperative influence on the identified person. Ectopic pregnancy embryos, villous tissue were completely cleared. In the preoperative discussion of the medical prescriptionthere was no diagnosis and treatment about the use of relevant drugs when necessary during the operation to prevent the occurrence of postoperative persistent ectopic pregnancy The record of the protocol, and the existing materials could not prove that the doctor had completely removed the embryo and villous tissue of the ectopic pregnancy during the operation, and the actual operation did not take methotrexate< /span>（MTX）Partial closure and other related measures. Therefore, there is a direct causal relationship between the medical party’s failure to fulfill the corresponding diagnosis and treatment obligations for the prevention of its occurrence . Comprehensive consideration of the appraiser’s own situation, the mistakes of the doctor in the process of diagnosis and treatment of the appraiser, and the risks of the medical treatment itself, the analysis concluded that < strong>MedicalThere is a causal relationship between the fault of the prescription and the injury consequences of the appraiser, and it is suggested that the causal force should be the main reason.
Judgment
The court of first instance held that, based on the content of the forensic expert opinion, combined with the expert’s trial statement and the actual situation of the case, it could be determined that there was a correlation between the hospital’s fault and the patient’s left salpingectomy, and the hospital should be responsible for 75 % of the liability for compensation is more appropriate, and the hospital was ordered to compensate the patient 140,000. The hospital appealed against the judgment, and the court of second instance upheld the hospital’s 75% liability for compensation.
Case in case
Ectopic pregnancy refers to the implantation of an egg outside the uterine cavity Abnormal developmental pregnancy, also known as “ectopic pregnancy”, is most common in tubal pregnancy. The treatment method is mainly surgery. For patients without fertility requirements, salpingectomy can be performed. For patients with fertility requirements, conservative treatment, including drug therapy, is preferred. and tubal fenestration. In this case, the hospital gave priority to conservative treatment, the fenestration of the fallopian tubes was performed, and there was no inappropriate treatment method, but Persistent ectopic pregnancy may result if the embryo sac is not completely removed during surgery or if viable trophoblasts remain and continue to grow. After identification, there is no record of the hospital’s careful inspection of the integrity of the embryo tissue and the detailed investigation of the possible residual villus tissue. Physical examination did not reveal clear placental villi, so the court found that the hospital was at fault. This case also reminds medical staff that when performing similar operations, they should conduct detailed inspections, exercise due diligence, and keep surgical records. Responsible for safety. In addition to exercising due diligence during the operation, the preoperative discussion system should be implemented before the operation. The preoperative discussion system refers to the purpose of reducing the risk of surgery and ensuring the safety of surgery. , surgical methods, expected effects, surgical risks and treatment plans, etc. to discuss the system, requirementsThe scope of preoperative discussion includes surgical group discussion, physician team discussion, ward discussion and general practice discussion. Clinical departments should clarify the scope of preoperative discussions at all levels of operations carried out by the department and have them approved by the medical management department. The general practice discussion shall be chaired by the head of the division or its authorized deputy head, and the medical management department and relevant departments shall be invited to participate if necessary. If the patient’s operation involves multiple disciplines or there are complications that may affect the operation, the relevant departments should be invited to participate in the discussion, or the consultation of the relevant disciplines should be completed in advance. In this case, in the preoperative discussion in the hospital, there was no the diagnosis and treatment plan of using relevant drugs when necessary during the operation to prevent the occurrence of persistent ectopic pregnancy after operation. The record was also found to be at fault by the court. In terms of drug treatment, MTX, as an anti-tumor drug, can inhibit the growth of cells. In the clinical treatment of patients, the combination of MTX injection and Houdingnuo has better effect and better safety, which can be promoted in clinical practice. As a result, MTX is also commonly used in obstetrics and gynecology to treat ectopic pregnancy, so that embryonic tissue growth is terminated, necrosis, shedding, and absorption. The forensic opinion in this case also mentioned “taking relevant measures such as partial closure of MTX”. It should be noted that due to the possibility of fatal or serious toxicity, MTX should only be used by physicians with experience in antimetabolite chemotherapy. must be used by a professional physician. Physicians must fully inform patients of the risks and should administer medication under their supervision. The Civil Code also stipulates that medical personnel shall explain the condition and medical measures to patients during diagnosis and treatment activities. If an operation, special examination, or special treatment is required, the medical staff shall explain the medical risks, alternative medical plans, etc. to the patient in a timely manner, and obtain their explicit consent; and obtain its express consent. Therefore, obstetricians and gynecologists must fulfill the obligation of clear notification and obtain the consent of patients before using MTX, so as to avoid legal risks.
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