Hirschelmann A, Wallwiener C W, Wallwiener M, Weyhe D, Tchartchian G, Hackethal A, De Wilde R L
Department of Gynaecology, Obstetrics and Gynaecological Oncology, Pius-Hospital, Oldenburg.
Division of Gynaecological Surgery, Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen.
Geburtshilfe Frauenheilkd. 2012 Apr;72(4):299-304. doi: 10.1055/s-0031-1298425.
Over the past decades, our knowledge and understanding of adhesions and adhesion-related complications has increasingly grown and it has become evident that adhesions have significant implications for patients, physicians and the healthcare system. The question arises whether this has resulted in greater awareness of adhesion-related problems among practicing physicians and appropriate patient education on this topic in daily practice. The following article provides a brief overview of the important subject of adhesions, discusses current awareness of adhesions among patients and doctors and addresses the consequences of failure to provide patient education and consent from a medical perspective. Selective literature searches were conducted in PubMed and the Cochrane Library. A patient information and consent form was developed based on several years' experience and expertise in the field of adhesions. Adhesions are the most common type of complication in abdominopelvic surgery today, with devastating consequences for some patients. Surveys investigating the awareness of adhesions among physicians and patients clearly showed that even well-informed physicians fail to educate their patients adequately. Such failure could potentially lead to successful medical malpractice lawsuits against doctors. Considering their clear clinical impact, adhesions and related consequences should always be discussed with patients preoperatively. A newly developed consent form that specifically addresses adhesion formation may serve to thoroughly educate patients preoperatively and to adequately document the process of doing so.
在过去几十年里，我们对粘连及与粘连相关并发症的认识和理解不断加深，很明显，粘连对患者、医生和医疗保健系统都有重大影响。问题是，这是否已让执业医生对与粘连相关的问题有了更高的认识，并在日常实践中对患者进行了适当的相关教育。以下文章简要概述了粘连这一重要主题，讨论了患者和医生目前对粘连的认识，并从医学角度探讨了未能对患者进行教育及未取得患者同意的后果。我们在PubMed和考克兰图书馆进行了选择性文献检索。基于在粘连领域多年的经验和专业知识，我们制定了一份患者信息及同意书。粘连是当今腹部盆腔手术中最常见的并发症类型，对一些患者会产生毁灭性后果。调查医生和患者对粘连认识的研究清楚表明，即使是见多识广的医生也没有对患者进行充分的教育。这种疏忽可能会导致针对医生的成功医疗事故诉讼。鉴于粘连明确的临床影响，术前应始终与患者讨论粘连及其相关后果。一种专门针对粘连形成的新制定的同意书，可能有助于在术前对患者进行全面教育，并充分记录这一过程。
