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颈部手术中手术失误及并发症的法医学影响:基于意大利现行法律的综述

Medicolegal implications of surgical errors and complications in neck surgery: A review based on the Italian current legislation.

作者信息

Polistena Andrea, Di Lorenzo Pierpaolo, Sanguinetti Alessandro, Buccelli Claudio, Conzo Giovanni, Conti Adelaide, Niola Massimo, Avenia Nicola

机构信息

University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy.

Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.

出版信息

Open Med (Wars). 2016 Aug 2;11(1):298-306. doi: 10.1515/med-2016-0058. eCollection 2016.

Abstract

Aim of the present paper is the review of the principal complications associated to endocrine neck surgery considering how expertise, full adoption of guidelines, appropriate technology and proper informed consent may limit the medicolegal claims at the light of the incoming new regulation of the medical professional legal responsibility. A literature search, using the Medline/PubMed database for full-length papers, was used. Postoperative recurrent laryngeal nerve (RLN) palsy and hypoparathy-roidism remain the principal causes of surgical malpractice claims . In the procedure of neck lymphadenctomy intra-operative haemorrhage, thoracic duct injury, injuries to loco-regional nerves can be observed and can be source of claims. After many years of increased medicolegal litigations, the Italian government is proposing a drastic change in the regulations of supposed medical malpractice in order to guarantee the patient's right to a safe treatment and in the meantime to defend clinicians from often unmotivated and prejudicial legal cases. Surgical errors and complications in neck surgery are a relevant clinical issue. Only the combination of surgical and clinical expertise, application of guidelines, appropriate technology and a routinely use of specific informed consent can contain potential medicolegal implications.

摘要

本文旨在回顾与颈部内分泌手术相关的主要并发症,并考虑在即将出台的医疗专业法律责任新规定的背景下,专业技能、全面遵循指南、适当的技术以及恰当的知情同意如何能够限制医疗法律索赔。我们使用Medline/PubMed数据库检索了全文文献。术后喉返神经(RLN)麻痹和甲状旁腺功能减退仍然是医疗事故索赔的主要原因。在颈部淋巴结清扫术中,可观察到术中出血、胸导管损伤、局部区域神经损伤,这些都可能成为索赔的原因。经过多年医疗法律诉讼的增加,意大利政府提议对所谓的医疗事故法规进行重大改革,以保障患者获得安全治疗的权利,同时保护临床医生免受往往毫无根据且有偏见的法律案件的困扰。颈部手术中的手术失误和并发症是一个重要的临床问题。只有将手术和临床专业技能、指南的应用、适当的技术以及常规使用特定的知情同意相结合,才能控制潜在的医疗法律影响。

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