肿瘤专科医院非计划再次手术原因分析及对策研究

目的]探讨肿瘤专科医院非计划再次手术的原因,加强非计划再次手术的监督与管理,提高手术质量,保障医疗质量安全.方法]回顾性分析某三级甲等肿瘤专科医院2013～2015年163例非计划再次手术病例,对非计划再次手术的发生原因进行调查分析.结果]肿瘤手术患者非计划再次手术发生率为0.35％,主要集中在胃肠外科、胸外科及神经外科,发生的主要原因为术区出血(53例,占32.52％),其次为术中损伤(25例,占15.34％)、术后切口裂开(22例,占13.50％)、吻合口瘘(9例,占5.52％)、术后切口感染(9例,占5.52％)等问题.结论]加强重点科室、重点环节、重点病例和重点人群的监管,做好手术医师分级准入与再考核再授权制度是降低非计划再次手术发生率的重要保障.同时,加强手术医师对非计划手术发生原因的认识,加强围手术期管理,可降低非计划再次手术的发生率.

Cause of Unplanned Reoperation in a Cancer Hospital and Relevant Countermeasures

Purpose] To analyze the causes of unplanned reoperation in a cancer hospital and relevant countermeasures.Methods] Total 163 patients who had experienced unplanned reoperation in a tertiary tumor hospital from 2013 to 2015,and the causes of reoperation were analyzed retrospectively.Results] The unplanned reoperation rate in this hospital was 0.35％,mainly in patients with gastrointestinal surgery,thoracic surgery and neurosurgery.The leading cause of reoperation was surgical site bleeding(n=53,32.52％),followed by intraoperative injury(n=25,15.34％),postoperative incision dehiscence(n=22,13.50％),anastomotic fistula(n=9,5.52％),postoperative incision infection(n=9,5.52％) and others.Conclusion] The causes of unscheduled reoperation are various and corresponding measures should be taken.