彭书雅 夏文涛

【摘 要】 机会丧失医疗纠纷案件在我国司法鉴定实践中并不少见，但较少有关机会丧失理论的文献报道。 本文通过回顾1例胆囊癌延误治疗及 1 例胰腺癌延误诊治的医疗损害赔偿责任纠纷案例，探讨类似案例中因果关系分析及参与程度判定的方法与原则。案例 1 中，医方疏忽石蜡病理诊断结果“胆囊癌”。案例2中，医师有违当时医疗水准，“疏忽”了明显的胰腺CT改变，未做进一步检查的提示与告知。因医师存在上述医疗过错，使患者失去了进一步治疗的机会。疾病本身的严重性固然是患者最终死亡的主要原因，但根据“机会丧失”学说与流行病学调查结果，鉴定人认为医疗过错与患者死亡也存在一定的因果关系，最终判定两案例过错对后果的参与程度分别为30%与10%左右。

【关键词】 胆囊癌；胰腺癌；丧失机会；因果关系；过错参与程度

【中图分类号】 D918.9

【文献标示码】 A

【文章编号】 1674-1226（2013）03-0354-06

On Causation and Degree of Contribution in Medical Disputes Concerning Loss of Chance. Peng Shuya^1，2，Xia Wentao². 1. Department of Forensic Medicine，Medical College of Soochow University，Suzhou 215123，China；2. Shanghai Key Laboratory of Forensic Medicine，Institute of Forensic Science，Ministry of Justice，P.R. China，Shanghai 200063，China.

【Abstract】 Cases concerning the loss of chance are by no means infrequent in the practice of forensic assessment of medical cases in China, but fewer theory about loss of chance has been reported. This article analyzed the method and principle of causation and contribution evaluation through reviewing two cases related to gallbladder and pancreatic cancer respectively, which involved medical liability for impairment. In the first case, the hospital was negligent about the paraffin pathological diagnosis of gallbladder cancer. In the second case, the hospital failed to meet the present clinical medical standard by “neglecting” the abnormal changes showing in the CT imaging and didn’t give the patient any prompt or notification for additional examination. The sufferers lost the chance of further treatment due to these above medical faults. It’s clear that the seriousness of the disease mainly led to the patients’ death. But on the other hand, according to the “loss of chance” theory and epidemiological findings, there are also some causal relationship between the two medical mistakes and deadly consequences, and it was found that the contribution of fault to the consequences in the two cases was 30% and 10%, separately.

【Key Words】 Forensic Medicine， Gallbladder Cancer， Pancreatic Cancer， Loss of Chance， Causation，Degree of Contribution