Objective To determine the trend in the causes of admission among diabetic patients in West China Hospital from 1996 to 2005. Methods The medical records of diabetic inpatients from January 1996 to December 2005 were retrieved, and half of them were randomly selected. A questionnaire was completed and SPSS13.0 software was used for statistical analyses. Results The most common causes of admission for diabetic patients were diabetic chronic complications (20.2%), infection (19.5%), hyperglycemic symptoms (11.7%), malignant tumor (8.9%) and diabetic acute complications (5.8%). The constituent ratios of diabetic macrovascular disease and malignant tumor as the admission causes tended to increase, while the constituent ratios of diabetic microvascular disease, hyperglycemic symptoms and diabetic acute complications tended to decrease. Infection remained as one of the main causes of admission among diabetic patients. Conclusion The main cause of admission to West China Hospital for diabetic patients from 1996 to 2005 was diabetic chronic complications.
目的:探討膽石癥再次手術的原因及預防措施。方法:對我院過去5年收治的134例膽石癥再次手術病例的臨床資料進行回顧性分析。結果:膽石癥再次手術主要原因為結石殘留或復發(86.57%),醫源性膽管損傷(4.48%),拔除T管后膽汁性腹膜炎(4.48%),殘留膽囊炎伴結石(2.99%),膽腸吻合口狹窄伴結石(1.49%)等。再次手術方式以膽總管切開取石膽道鏡檢查取石“T”形管引流術、膽總管十二指腸側側吻合術,肝膽管空腸Roux-en-Y吻合術,肝葉段切除,殘留膽囊切除術為主。本組患者痊愈131例,死亡3例,死亡率2.29%,術后殘石率5.17%.結論:對于膽石癥,無論是首次手術還是多次手術,均應做好術前檢查,制定周密的手術計劃,利用膽道外科和肝臟外科技術,努力貫徹去除病灶,解除梗阻,通暢引流三原則,力爭將殘石率、復發率、再手術率降低到最低限度。
【摘要】 目的 探討顱腦損傷(BI)死亡的法醫病理學特點,以及繼發性腦干損傷、并發癥的發生與死亡之間的因果關系。方法 從性別、年齡、致傷方式、損傷類型、生存時間、死亡原因等方面,對四川大學華西法醫學鑒定中心1998年1月-2008年12月127例BI死亡尸檢案例進行回顧性統計研究分析。結果 127例法醫病理學檢案中,原發性BI死亡51例(402%),繼發性腦干損傷死亡61例(480%),并發癥死亡15例(118%),其中傷后12 h內死亡者直接死因均為嚴重原發性腦損傷,存活12 h～1周者直接死因以繼發性腦干損傷居多,生存時間超過1周者約半數死于并發癥。結論 在BI案例的死亡原因確定時,應在全面系統的病理學檢驗基礎上,結合案情及臨床資料進行綜合分析。【Abstract】 Objective To explore the characteristics of forensic pathology in traumatic brain injury and the relationships between secondary brainstem damage, complications and the causes of death. Methods 127 cases were reviewed from gender, age, manner of injury, survival time and the direct causes of death from January 1998 to December 2008. Results Of the 127 cases, the key direct cause of death was secondary brainstem damage, followed by severe primarily brain injury and complications. For those who died within 12 hours after injury, the direct cause was severe primarily brain injury; for those who survived between 12 hours to one week, secondary brainstem damage was in the majority of the causes and for those who survive more than one week time, complication was an important cause. Conclusion In the cases of traumatic brain injury, we should take comprehensive and systematic examination of forensic pathology, and refer to clinical data at the same time to determine the direct cause of death.
【摘要】 目的 探討新生兒死亡醫療糾紛中臨床及法醫病理學特點,啟示兒科醫護人員在防范此類醫療糾紛時應注意的相關問題。方法 對四川大學華西基礎醫學與法醫學院法醫病理教研室1998年1月—2007年12月的60例新生兒死亡尸檢案例進行回顧性統計分析。結果 60例中除3例非正常死亡外,57例為自然性疾病死亡。其中出生后24 h死亡32例(56.1%),死亡男嬰40例(70.2%)。死亡原因主要為胎糞吸入綜合征、肺透明膜病、肺出血等窒息性疾病(49.1%)。其中醫療過失性糾紛21例(36.8%),醫療過失的原因主要為觀察不仔細、處理不及時、誤診漏診、產前檢查或助產處理不當、告知不足等。涉及糾紛的醫院以市級醫院居多(58.7%)。結論 醫護人員應嚴格遵守診療常規和操作規范,對新生兒加強監護,及時搶救,同時應積極與家屬溝通,以減少醫療糾紛的發生。
ObjectiveTo explore the causes of bile duct injury due to laparoscopic cholecystectomy (LC) and the preventive methods. MethodsA total of 18 patients with bile duct injury (with the occurrence rate of 0.4%) after LC between January 2003 and December 2012 were included. The patients included 5 males and 13 females with the age of 29-63 years old[averaging (42.3±3.6) years old]. The clinical data of the patients were retrospectively analyzed. ResultsIn the 18 cases of bile duct injury, 5 cases occur in emergency operation, 13 cases in selective operation. The operators were attending physician in 13 cases, and senior position in the other 5 cases. The reasons of the injury included misjudgment of the cystic duct in 9, duct aberrance in 3, excessive stretch of cystic duct in 2, 2 Mirizzi syndrome withⅠ-type surgical injury in 2, and right liver duct injury because of inappropriate stripping of gallbladder in 1. ConclusionThe operator's experience, severe conglutination and the bile duct aberrance are the chief causes. Preventive methods include strict system of operation accession, careful selection of candidates, timely laparotomy, and paying attention to the accumulation of operation experience and skills.
ObjectiveTo systematically review the current status of doctor-patient conflicts in China.MethodsWe searched CNKI and CSSCI databases to collect literatures about the doctor-patient conflicts from inception to April 23rd, 2017. The literatures were categorized by the published time, the high-frequency vocabulary, the citation frequency, the researching discipline, the researching facility, the quality of literature, the theme of literature and so on. The current research status of the doctor-patient conflicts was analyzed.ResultsA total of 226 literatures were included, in which 72 defined and classified the doctor-patient conflicts, 122 analyzed the causing reasons of doctor-patient conflicts, and 160 analyzed the governance paths of doctor-patient conflicts. The research disciplinary vision was limited to the policies, regulations and the medical education and so on, and the researches in psychology or economics disciplinary vision were insufficient. The medical and comprehensive universities were the main research units of the studies of the doctor-patient conflicts. The frequency and quality of the researches about doctor-patient conflicts were low.ConclusionThe classified studies of doctor-patient conflicts are insufficient, so the scientific and manageable classified criterions are needed in the further studies. Systematic studies in influential factors of doctor-patient conflicts are insufficient, so the occurring mechanisms of conflicts are needed to be done by systematical researches on patient-centered way. The studies of governance paths of doctor-patient conflicts are insufficient, so the strategies of classified and systematical management which according to the different conflicting forms and entire process of the conflict occurrence should be put forward.
Objective To establish a stable model of orthotopic liver transplantation (OLT) using donation after cardiac death (DCD) in rat, and to analyze death causes within 24 h after OLT, then explore appropriate treatment strategies for it. Methods The heart arrested 10 min before liver graft harvesting. The rat OLT model using DCD was performed by Kamada two-cuff technique. The operative time and death were recorded. Results One hundred OLT models using DCD were performed successfully within 40 d, the donor operative time was (20±5) min, the recepient operative time was (55±5) min, the anhepatic phase was (20±3) min. Nine rats were died during the operation, including 4 cases of massive haemorrhage, 1 case of anesthesia accident, 1 case of longer anhepatic phase, 1 case of sleeve implant failure, and 2 cases of aeroembolism. Twenty-two rats died within 12 h after the operation, including 6 cases of intestinal necrosis, 6 cases of anastomotic bleeding, 3 cases of pulmonary edema, 4 cases of intraoperative massive haemorrhage, 2 cases of vascular embolism, and 1 case of unexplained death. Nineteen rats died 12–24 h after the operation, including 9 cases of intestinal necrosis, 3 cases of anastomotic bleeding, 2 cases of pulmonary edema, 1 case of intraoperative massive haemorrhage, 1 case of vascular embolism, and 3 cases of unexplained death. Conclusions There are many reasons resulting in early death of rat OLT using DCD, postoperative intestinal necrosis, intraoperative and postoperative bleeding, and postoperative pulmonary edema are main causes. For these reasons, prevention and improvement measures are helpful to establish a stable model and improve a successful rate of rat OLT using DCD.