邱丽蓉 邓振华

（四川大学华西基础医学与法医学院，四川 成都 610041）

【摘 要】基于法院手术遗留异物的医疗损害判决案件为研究资料，对此类案件的基本特征进行探究，了解手术遗留异物医疗诉讼案例的特征，为规范医师行为，减少医疗诉讼，提高医方应诉能力，为国内医 疗损害后果评定标准完善提供参考。对中国裁判文书网上传的 2013 年至 2016 年间 122 例术中遗留异物案 件法院判决文书材料进行分析，提取案例中患者损害后果；医疗事故等级；医疗损害参与度及案件判决、赔 偿情况信息等。数据统一使用 Excel 表格录入，SPSS19.0 对数据进行统计学分析。在进行伤残等级评定 的 73 例判决案例中，九级伤残最多（20例，27.0%），其次是十级伤残（16例，21.6%）。医疗过错参与度 提示医疗过错行为为患者诊疗不良后果主要或完全作用的最多（33例，56.9%），其次是次要作用（10例，17.2%）。90.8% 的患者在诉讼中获得赔偿。司法鉴定出具过错参与度理论值的鉴定意见与法院判决的医疗损 害责任程度之间具有较强的相关性。患者伤残等级与获得的赔偿额之间具有相关性。精神损害赔偿占所有 赔偿的11.8%，89例（73.0%）有精神损害赔偿，23例（18.6%）无精神损害赔偿。患者伤残等级与精神损 害赔偿额之间具有相关性。案例从法院立案到结案的平均审理期限为9个月。手术中遗留异物法院判决案 件中患者的不良后果多为九级伤残、十级伤残或不构成伤残，医疗过错行为是患者最终不良后果的主要原 因或直接原因，法院审理此类案件高度依赖司法鉴定意见，且患者胜诉率较高，对于明确存在术中遗留异 物的患者应适当予以一定程度的精神损害赔偿。国内针对患者医疗损害不良后果的评定标准有待完善。

【关键词】遗留异物；医疗诉讼；法院判决

【中图分类号】D915.13

【文献标识码】A

【文章编号】1674-1226（2018）02-0218-11

Case study about remained surgical items. Qiu Lirong, Deng Zhenhua (West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, Sichuan 610041, China.)

【Abstract】By taking medical damage cases about remained surgical items (RSI) as research materials, this article explores the basic characteristics of such cases. By understanding these characteristics, it provides a reference for regulating the behaviors of physicians, reducing medical malpractice litigations and improving the ability of physicians/hospital in responding to lawsuits, as well as improving the assessment criteria of medical damage consequences in China. This article analyzes judicial judgements of 122 RSI medical damage cases from 2013 to 2016 from China Judgements Online and extracts information about damage consequences of the patients, medical accident grade,medical damage participation degree, judgements and compensation, etc. All such data was consolidated in Excel tables and analyzed statistically by SPSS 19.0. Among the 73 cases involving disability assessment, grade nine is the most (20 cases, 27%), followed by grade ten (16 cases, 21.6%). According to medical malpractice participation degree, the medical malpractice takes the most or complete responsibility for adverse consequences (33 cases, 56.9%), followed by secondary responsibility (10 cases, 17.2%). 90.8% of the patients gained compensation in the lawsuit. There is a strong correlation between the appraisal opinion about theoretical value of the fault participation degree written by judicial expertise and the medical damage liability degree decided by court. There is also a correlation between the patient’s disability grade and the amount of compensation. The compensation for mental injury accounted for 11.8% of all compensations; there were 89 cases (73%) involving mental damages, and 23 (18.6%) are not. There is a correlation between patient’s disability degree and compensation for mental injury. The average trial period from case filing to completion is 9 months. In the cases of RSI, most of patients' adverse consequences are disability grade nine, grade ten or no disability, and medical malpractice is the main reason or the direct reason for the adverse consequences of patients.RSI cases are highly dependent on judicial expertise, and the patients are more likely to win. For patients who are clearly diagnosed with RSI, a certain degree of compensation for mental injury should be given. The criteria for assessing the adverse consequences of medical damage for patients need to be improved.

【Key Words】 Remained surgical items, Medical malpractice litigation, Judicial judgement