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产妇术后遗留15cm止血钳，15个月后才被取出！

2021-09-06 梅斯医学 MedSci原创

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2020年6月，祝女士在禹州市妇幼保健院剖宫产后一直感到腰腹部疼痛，今年8月，患者前往禹州市中医院检查，腹部正位片竟提示，腹腔内有一15公分的止血钳！

2020年6月，祝女士在禹州市妇幼保健院剖宫产后一直感到腰腹部疼痛，今年8月，患者前往禹州市中医院检查，腹部正位片竟提示，腹腔内有一15公分的止血钳！
 
 
产后遗留止血钳，哪家医院该负责？
 
祝女士家属怀疑这把长达15公分的止血钳，是其在禹州市妇幼保健院生产时被医生遗留在腹中的，但该医院医生则表示，术中器械核查清单显示清点无误，止血钳有可能是另一次手术时遗留在腹腔内的。

据悉，祝女士共做过三次手术，

  • 2011年曾于郑州某医院行胃部手术；

  • 2015年曾于平顶山市鲁山县人民医院行剖宫产手术；

  • 最后一次则是去年6月在禹州市妇幼保健院所做的剖宫产手术。

 
9月2日祝女士找到禹州市卫健委，卫健委医政科工作人员明确表示，这是一起重大的医疗事故，将会一查到底绝不姑息！
 
9月4日上午，祝女士在郑州人民医院顺利完成取钳手术。目前，祝女士已被转移到病房，术后状态良好。在司法鉴证机构与当地媒体的监督下，止血钳被送往病理科进行检验并封存，随后他们将邀请相关专家进行鉴定，并出具完整的司法鉴定意见。
术中异物遗留，频频发生敲响警钟！
 
病人体内遗留器械耗材，看似不可思议，但搜索相关新闻不难发现，这样的案例并不少见。
 
2018年6月，四川攀枝花一名42岁的中年妇女在当地一家民营医院做完剖宫引产手术后，被腹痛折磨持续四个月后不幸离世。最终尸检发现，死者的小肠肠腔内遗留有三块纱布。
 
2017年9月，郭女士在连云港市第一人民医院产科生产后一直腹痛难忍，连续三个月消炎治疗未见缓解，直到她意外在洗澡时从自己身体里扯出一块发臭的纱布。
 
2015年3月，朱先生因右耳耳道内骨瘤于惠州市中心人民医院行手术治疗，术后出现面瘫症状，CT显示右侧外耳道有“短条状高密度影”的异物，二次手术竟发现该异物为0 .3cm×0 .7cm的手术器械断片。
 
有文献对2013年1月1日至2017年12月31日期间江苏省药品不良反应监测中心收集的101 例医疗器械形成异物遗留体内的可疑不良事件报告作一分析1。
 
这些不良事件中，有些是因为产品质量原因导致器械使用过程中断裂遗留体内，但从表中我们也会发现，遗留异物中不乏有橡胶外科手套、手术刀片、止血钳、外科用剪等，这些异物中50.5%最终都通过额外手术重新取出。
 
术中异物遗留同样也是一个全球性的问题。据文献报道，2008年，美国每5500例手术中就有1例发生手术异物遗留。
 
研究人员统计了数据库中308种术中遗留的异物，其中包括器械（33.1%）、导管或引流管（16.9%）、针头和刀片（10.7%）、包装（9.7%）、植入物（4.5%）、标本（1.9%）和各种其他物品（23.1%）。
 
研究还发现，发生术中异物遗留最多的专科是产科和妇科（25.9%），其次是普通外科（19.8%）、骨科（18.7%）和心胸外科（10.4%）。另有25.2%的事件发生在14个其他专业2。
 
（图片来自参考文献2）
 
 
异物遗留究竟如何避免？
 
众所周知，手术前后有着严格的核查制度。在手术开始前，关闭空腔脏器前、关闭体腔前、以及关闭皮肤后，医生、器械护士、巡回护士都要对手术物品进行清点。
原卫生部2010年发布的《手术安全核查制度》也对相关内容及流程作出了具体规定，其中第五条第（三）项规定“患者离开手术室前：三方共同核查患者身份（姓名、性别、年龄）、实际手术方式，术中用药、输血的核查，清点手术用物，确认手术标本，检查皮肤完整性、动静脉通路、引流管，确认患者去向等内容。”
 
但事实上，大约80%的案例是那些在手术结束时报告材料数量正确的病例3。另一重要因素可能是目前手术中的器械耗材众多，质量问题或操作不当导致零件、碎片残留体腔，这就需要术者在操作过程中时刻谨慎，以及术后仔细检查器械是否损坏。
 
总之，制度的制定可以做到各个环节百分之百的精确，但最终的执行质量却只能依靠每一位手术室里的医生护士了。
 
健康所系，性命相托，为了每一位患者的生命安全，也为了自己的职业前途，各位同仁在手术台上请务必慎之又慎！
  
References
1.卞蓉蓉 李, 赵敏,马丹华,宋杏芳,杨婷婷. 101例医疗器械形成异物遗留患者体内的不良事件. 医疗装备. 2018:49-51.
2.Steelman VM. Retained Surgical Items: Evidence Review and Recommendations for Prevention. AORN journal. 2019;110(1):92-96.
3.Zejnullahu VA, Bicaj BX, Zejnullahu VA, Hamza AR. Retained Surgical Foreign Bodies after Surgery. Open access Macedonian journal of medical sciences. 2017;5(1):97-100.

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    2022-05-03 habb

    #止血钳#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=2056395, encodeId=36d12056395c7, content=<a href='/topic/show?id=b38a63184f9' target=_blank style='color:#2F92EE;'>#止血钳#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63184, encryptionId=b38a63184f9, topicName=止血钳)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=19c567, createdName=habb, createdTime=Tue May 03 23:22:11 CST 2022, time=2022-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1016741, encodeId=fe801016e4107, content=。。。。。。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8c212549013, createdName=1253a726m50(暂无昵称), createdTime=Sun Sep 12 11:50:47 CST 2021, time=2021-09-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1263099, encodeId=44851263099ba, content=<a href='/topic/show?id=ebb5631e076' target=_blank style='color:#2F92EE;'>#止血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63170, encryptionId=ebb5631e076, topicName=止血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6f7770, createdName=jeanqiuqiu, createdTime=Wed Sep 08 00:22:11 CST 2021, time=2021-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1014981, encodeId=cbc31014981f5, content=三个人数数都能数错？, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7dde5460776, createdName=ms9000001807328867, createdTime=Mon Sep 06 10:24:26 CST 2021, time=2021-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015031, encodeId=e363101503111, content=好文章，值得一读。, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Mon Sep 06 13:15:32 CST 2021, time=2021-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015029, encodeId=e0651015029cc, content=不幸的事情, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1cc45580359, createdName=ms4000001678217026, createdTime=Mon Sep 06 13:02:13 CST 2021, time=2021-09-06, status=1, ipAttribution=)]
    2021-09-12 1253a726m50(暂无昵称)

    。。。。。。。。

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=2056395, encodeId=36d12056395c7, content=<a href='/topic/show?id=b38a63184f9' target=_blank style='color:#2F92EE;'>#止血钳#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63184, encryptionId=b38a63184f9, topicName=止血钳)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=19c567, createdName=habb, createdTime=Tue May 03 23:22:11 CST 2022, time=2022-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1016741, encodeId=fe801016e4107, content=。。。。。。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8c212549013, createdName=1253a726m50(暂无昵称), createdTime=Sun Sep 12 11:50:47 CST 2021, time=2021-09-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1263099, encodeId=44851263099ba, content=<a href='/topic/show?id=ebb5631e076' target=_blank style='color:#2F92EE;'>#止血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63170, encryptionId=ebb5631e076, topicName=止血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6f7770, createdName=jeanqiuqiu, createdTime=Wed Sep 08 00:22:11 CST 2021, time=2021-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1014981, encodeId=cbc31014981f5, content=三个人数数都能数错？, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7dde5460776, createdName=ms9000001807328867, createdTime=Mon Sep 06 10:24:26 CST 2021, time=2021-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015031, encodeId=e363101503111, content=好文章，值得一读。, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Mon Sep 06 13:15:32 CST 2021, time=2021-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015029, encodeId=e0651015029cc, content=不幸的事情, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1cc45580359, createdName=ms4000001678217026, createdTime=Mon Sep 06 13:02:13 CST 2021, time=2021-09-06, status=1, ipAttribution=)]
    2021-09-08 jeanqiuqiu

    #止血#

    0

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    2021-09-06 ms9000001807328867

    三个人数数都能数错？

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=2056395, encodeId=36d12056395c7, content=<a href='/topic/show?id=b38a63184f9' target=_blank style='color:#2F92EE;'>#止血钳#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63184, encryptionId=b38a63184f9, topicName=止血钳)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=19c567, createdName=habb, createdTime=Tue May 03 23:22:11 CST 2022, time=2022-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1016741, encodeId=fe801016e4107, content=。。。。。。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8c212549013, createdName=1253a726m50(暂无昵称), createdTime=Sun Sep 12 11:50:47 CST 2021, time=2021-09-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1263099, encodeId=44851263099ba, content=<a href='/topic/show?id=ebb5631e076' target=_blank style='color:#2F92EE;'>#止血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63170, encryptionId=ebb5631e076, topicName=止血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6f7770, createdName=jeanqiuqiu, createdTime=Wed Sep 08 00:22:11 CST 2021, time=2021-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1014981, encodeId=cbc31014981f5, content=三个人数数都能数错？, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7dde5460776, createdName=ms9000001807328867, createdTime=Mon Sep 06 10:24:26 CST 2021, time=2021-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015031, encodeId=e363101503111, content=好文章，值得一读。, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Mon Sep 06 13:15:32 CST 2021, time=2021-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015029, encodeId=e0651015029cc, content=不幸的事情, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1cc45580359, createdName=ms4000001678217026, createdTime=Mon Sep 06 13:02:13 CST 2021, time=2021-09-06, status=1, ipAttribution=)]
    2021-09-06 yangchou

    好文章，值得一读。

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=2056395, encodeId=36d12056395c7, content=<a href='/topic/show?id=b38a63184f9' target=_blank style='color:#2F92EE;'>#止血钳#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63184, encryptionId=b38a63184f9, topicName=止血钳)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=19c567, createdName=habb, createdTime=Tue May 03 23:22:11 CST 2022, time=2022-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1016741, encodeId=fe801016e4107, content=。。。。。。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8c212549013, createdName=1253a726m50(暂无昵称), createdTime=Sun Sep 12 11:50:47 CST 2021, time=2021-09-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1263099, encodeId=44851263099ba, content=<a href='/topic/show?id=ebb5631e076' target=_blank style='color:#2F92EE;'>#止血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63170, encryptionId=ebb5631e076, topicName=止血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6f7770, createdName=jeanqiuqiu, createdTime=Wed Sep 08 00:22:11 CST 2021, time=2021-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1014981, encodeId=cbc31014981f5, content=三个人数数都能数错？, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7dde5460776, createdName=ms9000001807328867, createdTime=Mon Sep 06 10:24:26 CST 2021, time=2021-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015031, encodeId=e363101503111, content=好文章，值得一读。, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Mon Sep 06 13:15:32 CST 2021, time=2021-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015029, encodeId=e0651015029cc, content=不幸的事情, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1cc45580359, createdName=ms4000001678217026, createdTime=Mon Sep 06 13:02:13 CST 2021, time=2021-09-06, status=1, ipAttribution=)]
    2021-09-06 ms4000001678217026

    不幸的事情

    0