| Objective: By collecting and studying the surgical treatment of the patients in the Chaohu Affiliated Hospital of Anhui Medical University from January 2012 to December 2015,and reading a large number of domestic and foreign literature,to explore risk factors of unplanned reoperation of the department of obstetrics and gynecology,give suggestion to clinical doctors on key points for treatment during the operation and perioperative period,and provide theoretical bases to improve the diagnosis and treatment measures,communication style,work methods and reduce medical disputes.Methods : This study collected the department of obstetrics and gynecology in the Chaohu Affiliated Hospital of Anhui Medical University from January 2012 to December 2015,a total of 8373 patients with surgery,including 20 cases of unplanned reoperation and each operation in a ratio of 1:5 cases of normal,as a case-conontrol study object(100 cases),refer to the above patient records and statistics of the basic information and the various factors affecting the reoperation related: age,obesity index,anamnesis(high blood pressure,diabetes),previous abdominal surgery,complications(anemia,hypokalemia,hypoalbuminemia,abnormal liver function),intraoperative blood loss,perioperative blood transfusion his-tory,emergency surgery or not,time of operation;initial operation way,operation level,summarizes the possible cause of the reoperation,and surgical operation method,operation again from the first operation time,hospitalization days,prognosis,and medical disputes,establish the database,application of statistical analysis software SPSS 19.0 to P < 0.05 is considered to have significant difference,statistically significant.Results:1.The rate of non-planned reoperation was 0.24 %(20/8373)in our department.2.The age of the patients in the reoperation group(39.30±13.235)years old,the age of the control group(39.58±13.775)years old,the difference was not statistically significant(t=-0.084,P=0.934).3.The reoperation group of 6 patients with abnormal obesity index,the control group of 21 patients with abnormal obesity index,the difference was not statistically significant(Χ2=0.408,P=0.523).4.The reoperation group of 2 patients with hypertension;the control group of 8patients with hypertension,the difference was not statistically significant(Χ2=0.443,P=0.454).5.The reoperation group of 3 patients with type 2 diabetes,the control group of 6patients with type 2 diabetes,the difference was statistically significant(Χ2=3.965,P=0.046).6.The reoperation group of 9 patients with previous abdominal surgery,the control group of 39 patients with previous abdominal surgery,the difference was statistically significant(Χ2=5.517,P=0.019).7.The reoperation group of 14 patients with anemia(Hb≤110g/L for the standard),the control group of 52 patients with anemia,the difference was statistically significant(X2=16.762,P=0.000).8.The reoperation group of 7 patients with hypoproteinemia(ALB≤35 g/L for the standard),the control group of 24 patients with hypoproteinemia,the difference was statistically significant(X2=6.159,P=0.013).9.The reoperation group of 3 patients with hypokalemia(K+≤3.5mmol/L for the standard),the control group of 33 patients with hypokalemia,the difference was not statistically significant(X2=0.000,P=1.000). 10.The reoperation group of 2 patients with abnormal liver function(ALT≥40u/L for the standard),the control group of 7 patients with abnormal liver function,the difference was not statistically significant(X2=0.560,P=0.454).11.The reoperation group of 6 patients with blood loss≥400ml during operation in primary operation,the control group of 13 patients with blood loss≥400ml during operation in primary operation,the difference was statistically significant(X2=9.921,P=0.002).12.The reoperation group of 9 patients with blood transfusion in perioperative period,the control group of 12 patients with blood transfusion in perioperative period,the difference was statistically significant(X2=27.671,P=0.000).13.The reoperation group of 4 patients with emergency operation,the control group of 21 patients with emergency operation,the difference was not statistically significant(X2=0.822,P=0.364).14.The reoperation group of 8 patients in non normal operation time(in the evening and holidays and other non normal working hours),the control group of 31 patients in non normal operation time,the difference was statistically significant(X2=5.897,P=0.015).15.The first operation method: 1 cases of emergency cesarean section,1 cases of partial bilateral ovarian resection in emergency cesarean section,1 cases of selective cesarean section,1 cases of forceps delivery,3 cases of lateral episiotomy,2 cases of difficult hysterectomy,2 cases of total hysterectomy,1 cases of subtotal hysterectomy with complication,2 cases of total hysterectomy under laparoscopy,1 cases of myomectomy,1 cases of ectopic IUD removed and Bladder repair,1 cases of unilateral fallopian tube resection,1 cases of induction of labor by rivanol + water sac induced labor and 2 case of primary cytoreductive surgery.16.First operation level: 20 cases of reoperation in grade three or above,(9/20),accounting for 45%.17.Causes of reoperation: Bleeding accounted for 25%,urinary injury accounted for 20%,incision healing accounted for 15% accounted for 10%,intestinal obstruction,intestinal injury accounted for 10%,accounted for 10% of infection related issues and pathology related problems accounted for 10 %.18.The reoperation mode: 2 cases of lower ureteral adhesion release + ureter bladder reimplantation,1 case of pelvic abscess debridement and excision of lesion,2cases ofsubtotal hysterectomy,3 cases of relaxation suture and percutaneous drainage,2cases of debridement and suture,2 cases of postpartum perineal hematoma,1 case of uterine repair,1 case of rectal repair and perineal repair,1 cases of intestinal adhesion lysis + right ureter double J tube implantation,1 cases of right ureter double J tube implantation,1 cases of bilateral accessory resection,1 cases of uterus and bilateral adnexectomy and pelvic lymph node dissection,1 cases of transabdominal bladder and bladder vaginal fistula repair,1 cases of intestinal adhesion lysis,1 cases of sigmoid colon fistula,1 cases of adhesiolysis and purulent fluid clearance and catheter drainage.19.The average interval from the reoperation to the primary operation was15.29±24.09 days.20.Hospital days: The average hospital days of the reoperation group is 33.70 ±40.832 days,the control group is 12.04 ±6.432 days,the two groups did not conform to the normal distribution,wilcoxon rank sum test was used,there is significant difference between them(Z=-4.099,P=0.000).21.Prognosis for patients: 4 cases of reoperation please famous expert to assist in the province,8 cases of multidisciplinary consultation and related departments collaborative surgery,20 patients are cured and discharged.22.Medical disputes: 20 cases of reoperation had medical disputes in 7 cases,Accounted for 35% of all the reoperation in my department,Accounted for 63.64% of the total number of disputes occurred in my department(7/11).Conclusion: The reoperation rate of our department was 0.24%.The patients with diabetes mellitus,anemia and hypoalbuminemia,had a history of abdominal surgery,primary surgical blood loss in more than 400 ml,perioperative blood transfusion and with abnormal time reoperation rate increased significantly.Level 2,3 surgery had high reoperation rate and high incidence of medical disputes.The most common and most dangerous cause of reoperation reason was bleeding. |
PDF Full Text Request