Kern K A
Department of Surgery, Hartford Hospital, CT.
Am J Surg. 1994 Sep;168(3):217-22. doi: 10.1016/s0002-9610(05)80189-8.
To understand the medicolegal impact of bile duct injury, we analyzed 68 cases of biliary injury resulting from open cholecystectomy and abdominal surgery. Cases were litigated within the US civil justice system between 1970 and 1991. Operations resulting in bile duct complications included cholecystectomy for cholelithiasis in 49 patients (72%), common bile duct exploration in 5 patients (7%), and other abdominal operations in 7 patients (10%); 7 operations were of unknown type. The average delay in recognition of injury was 16 days (range 3 to 42). The mortality rate was 18% (12 of 68). Median jury verdict awards in successfully litigated cases were twice that of out-of-court settlements ($500,000 versus $250,000, P = 0.01). Bile duct injury after open cholecystectomy and abdominal surgery has a high mortality rate when diagnosed late, and is expensive to litigate. This review may be useful in defining the medicolegal outcome of similar injuries from laparoscopic cholecystectomy.
为了解胆管损伤的法医学影响，我们分析了68例因开腹胆囊切除术和腹部手术导致的胆管损伤病例。这些病例于1970年至1991年间在美国民事司法系统中进行了诉讼。导致胆管并发症的手术包括49例（72%）因胆结石行胆囊切除术、5例（7%）胆总管探查术以及7例（10%）其他腹部手术；7例手术类型不明。损伤识别的平均延迟时间为16天（范围3至42天）。死亡率为18%（68例中有12例）。成功诉讼案件中陪审团裁决的中位数赔偿金是庭外和解的两倍（50万美元对25万美元，P = 0.01）。开腹胆囊切除术和腹部手术后的胆管损伤若诊断较晚则死亡率较高，且诉讼成本高昂。本综述可能有助于明确腹腔镜胆囊切除术类似损伤的法医学结果。
