妇产科手术分级(1).doc

relationship between Government and business. The two sessions, General Secretary of Pro, clear the word succinctly summarized the new relationship between Government and business, as pure politics, reshaping the political relationship specified in the direction. District leaders in handling political and business relations, engage in trading power for money, and finally stumbled, we a lesson, always keep in mind that Pro, clean practicing Pro, clear. Pro is to open a sincere engagement with private enterprise to help solve practical difficulties; Clear is to clarify the Division of power, exercised in accordance with, private entrepreneurs with innocent purity, not abusing power for personal gain, not to engage in trading power for money. Third, in order to maintain fairness and justice. Fairness and justice is the lifeline of the rule of law, is the best development environment. Currently, lax law enforcement and the judicial sector in our region also exist to varying degrees, law enforcement departments and individual window units power for personal gains and bribes, thick friends, relations, human cases, money cases in which seriously infringe on the legitimate rights and interests of enterprises and people. Especially some law enforcement and inspection for profit purposes, deliberately looking for corporate loopholes, found directly under the ticket does not give business improvement opportunities. We recruit a company doesnt easily, cultivating a business more difficult, never for personal gain, systematic harassment, card, last checked to check to get the enterprise collapsed. To guarantee the legitimate rights and interests. Always proceed from the overall situation of reform and development of services, fully consider the characteristics of production and management in non-public enterprises and social benefits, an accurate grasp of legal limits, protect the enthusiasm of entrepreneurs and practitioners in innovation and entrepreneurship, enhancing expectations and confidence. To promote strict enforcement. Strengthening law enforcement procedures, improve law enforcement performance evaluation, strengthening the supervision of law enforcement, exploration and practice of risk control mechanism of law enforcement to further standardize the social security, urban management, road traffic administrative law enforcement, effectively free, extensive law-enforcement and lax enforcement of law enforcement and other issues. To uphold justice. Justice is the last line of Defense to safeguard fairness and justice, to unequivocally support the courts and procuratorates independently exercise level . Judicial activities were rampant, must not be allowed to run, favors, money, must not be allowed to knowingly violate the miscarriage, violations of the legitimate rights and interests of the masses must not be allowed to abuse of power, to make forest mass can be felt in every judicial cases in equity and justice. Four to deepen grass-roots governance according to lawchain do long, and put scale big. To serve the development of enterprises. Duocuo simultaneously improving service efficiency, build better public services platform, enhance work efficiency, initiative to help businesses solve the project procedures, financing loans, issues such as land-use approval, reduce operating costs, business travel light and enhance the confidence to overcome all kinds of difficulties and the Foundation, real entrepreneurial passion play entrepreneurship, enhance the internal vitality and creativity. SI XING an construction, promoting the rule of law, tries to make the transformation of forest development XI General Secretary stressed, to reinvigorate Northeast China, optimized development environment is very important. Environment of rule of law most gather Moss, the most conducive to development. Improving the leading cadres using the method of thought and the rule of law Administration work, problem-solving, the ability to promote the development, is the key to promoting the rule of law. The law may affect the efficiency of out of the path of development will be more smooth, won development gains will be sustained, and end with greater efficiency. Leading cadres at all levels should take the lead in respect of law law, abide by, and actively foster Socialist culture, actively promoting the field of multi-level governance according to law, guide the masses and consciously abide by the law, failing to find law, solve the problem by law, in accordance with the law prevail. XXX administration by law of leading cadres do not exist on the rule of law, law enforcement, casual, and vow not to investors, the new scores and other turmoil. These important expositions on my district create good development environment with highly targeted and guidance, especially the General Secretary pointed out that the chaos in my area also exists to varying degrees, some even quite serious. Leading cadres at all levels must improve the development environment of rule of law as a fundamental task, adhere to the problem oriented, solid and solve the problems in the construction of rule of law, to rule the new effect for development environment improvements. To hold key minority. Leaders of this group, although few in number, but the effect is critical. If a local leaders take the lead right according to law, in accordance with the law, the local CPPCC fresh, pragmatic and efficient development environment. Conversely, if a local leaders of ignoring the law, impunity, not only the political environment will be destroyed, will have serious implications for the development environment. Now, some leading cadres lack of awareness on the importance of learning, that learn or not does not matter. Think efficiency is too low too much, act according to the procedure, than an executive order getting along with. In dealing with complex issues, often speak of settling and done; on the issue of handling letters and visits, like to spend money and buy stop and stable, but disregard the law administration, in accordance with the law, the rulechain do long, and put scale big. To serve the development of enterprises. Duocuo simultaneously improving service efficiency, build better public services platform, enhance work efficiency, initiative to help businesses solve the project procedures, financing loans, issues such as land-use approval, reduce operating costs, business travel light and enhance the confidence to overcome all kinds of difficulties and the Foundation, real entrepreneurial passion play entrepreneurship, enhance the internal vitality and creativity. SI XING an construction, promoting the rule of law, tries to make the transformation of forest development XI General Secretary stressed, to reinvigorate Northeast China, optimized development environment is very important. Environment of rule of law most gather Moss, the most conducive to development. Improving the leading cadres using the method of thought and the rule of law Administration work, problem-solving, the ability to promote the development, is the key to promoting the rule of law. The law may affect the efficiency of out of the path of development will be more smooth, won development gains will be sustained, and end with greater efficiency. Leading cadres at all levels should take the lead in respect of law law, abide by, and actively foster Socialist culture, actively promoting the field of multi-level governance according to law, guide the masses and consciously abide by the law, failing to find law, solve the problem by law, in accordance with the law prevail. XXX administration by law of leading cadres do not exist on the rule of law, law enforcement, casual, and vow not to investors, the new scores and other turmoil. These important expositions on my district create good development environment with highly targeted and guidance, especially the General Secretary pointed out that the chaos in my area also exists to varying degrees, some even quite serious. Leading cadres at all levels must improve the development environment of rule of law as a fundamental task, adhere to the problem oriented, solid and solve the problems in the construction of rule of law, to rule the new effect for development environment improvements. To hold key minority. Leaders of this group, although few in number, but the effect is critical. If a local leaders take the lead right according to law, in accordance with the law, the local CPPCC fresh, pragmatic and efficient development environment. Conversely, if a local leaders of ignoring the law, impunity, not only the political environment will be destroyed, will have serious implications for the development environment. Now, some leading cadres lack of awareness on the importance of learning, that learn or not does not matter. Think efficiency is too low too much, act according to the procedure, than an executive order getting along with. In dealing with complex issues, often speak of settling and done; on the issue of handling letters and visits, like to spend money and buy stop and stable, but disregard the law administration, in accordance with the law, the rule手术分级及妇产科手术分级一、手术的分类手术及有创操作分级手术指各种开放性手术、腔镜手术及麻醉方法（以下统称手术）。依据其技术难度、复杂性和风险度，将手术分为四级：一级手术：技术难度较低、手术过程简单、风险度较小的各种手术。二级手术：技术难度一般、手术过程不复杂、风险度中等的各种手术。三级手术：技术难度较大、手术过程较复杂、风险度较大的各种手术。四级手术：技术难度大、手术过程复杂、风险度大的各种手术。 二、手术医师级别依据其卫生技术资格、受聘技术职务及从事相应技术岗位工作的年限等，规定手术医师的级别。所有手术医师均应依法取得执业医师资格。1、住院医师（1）低年资住院医师：从事住院医师岗位工作3年以内，或获得硕士学位、曾从事住院医师岗位工作2年以内者。（2）高年资历住院医师：从事住院医师岗位工作3年以上，或获得硕士学位、取得执业医师资格、并曾从事住院医师岗位工作2年以上者。2、主治医师（1）低年资主治医师：从事主治医师岗位工作3年以内，或获得临床博士学位、从事主治医师岗位工作2年以内者。（2）高年资主治医师：从事主治医师岗位工作3年以上，或获得临床博士学位、从事主治医师岗位工作2年以上者。3、副主任医师：（1）低年资副主任医师：从事副主任医师岗位工作3年以内，或有博士后学历、从事副主任医师岗位工作2年以上者。（2）高年资副主任医师：从事副主任医师岗位工作3年以上者。4、主任医师:受聘主任医师岗位工作者。 三、各级医师手术权限(一)低年资住院医师：在上级医师指导下，可主持一级手术。(二)高年资住院医师：在熟练掌握一级手术的基础上，在上级医师临场指导下可逐步开展二级手术。(三)低年资主治医师：可主持二级手术，在上级医师临场指导下，逐步开展三级手术。(四)高年资主治医师：可主持三级手术。(五)低年资副主任医师：可主持三级手术，在上级医师临场指导下，逐步开展四级手术。(六)高年资副主任医师：可主持四级手术，在上级医师临场指导下或根据实际情况可主持新技术、新项目手术及科研项目手术。(七)主任医师：可主持四级手术以及一般新技术、新项目手术或经主管部门批准的高风险科研项目手术。(八)对资格准入手术，除必须符合上述规定外，手术主持人还必须是已获得相应专项手术的准入资格者。 四、手术审批程序1手术科室带组教授必须由主任医师或副主任医师担任，带组教授按医师级别确定组内每例手术的术者和助手名单。需要全科会诊的，至少提前1天交科主任组织全科会诊并审批。2科主任审批全科各医疗组每例手术的术者和助手名单，确保医师级别与手术分类相对应，签字生效。原则上，不批准越级手术。特殊情况下可以批准，但必须保证有上级医师在场指导。3患者选择医生时应以医疗组为单位，执行医师分级手术制度为前提。 五、手术审批权限手术审批权限是指对拟施行的不同级别手术以及不同情况、不同类别手术的审批权限。我院已施行电脑管理手术通知单，科主任及带组教授的书面签字应落实在术前小结的审批经过栏目中。常规手术：一级手术：带组教授审批，主管的主治医师以上医师报手术通知单。二级手术：带组教授审批，高年资主治医师以上医师报手术通知单。三级手术：科主任审批，由副主任医师以上医师报手术通知单。四级手术：科主任审批，由高年资副主任医师以上医师报手术通知单。 六、特殊手术审批权限1、资格准入手术资格准入手术是指按市级或市级以上卫生行政主管部门的规定，需要专项手术资格认证或授权的手术。由市级或市级以上卫生行政主管部门或其认可的专业学术机构向医院以及手术医师颁发专项手术资格准入证书或授权证明。已取得相应类别手术资格准入的手术医师才具有主持资格准入手术的权限。2、高度风险手术高度风险手术是指手术科室科主任认定的存在高度风险的任何级别的手术。须经科内讨论，科主任签字同意后报医务科，由医务科负责人决定自行审批或提交业务副院长审批，获准后，手术科室科主任负责审批。3、急诊手术预期手术的级别在值班医生手术权限级别内时，可施行手术。若属高风险手术或预期手术超出自己手术权限级别时，应紧急报告带组教授审批，必要时向科主任上报。但在需紧急抢救生命的情况下，在上级医师暂时不能到场主持手术期间，值班医生在不违背上级医生口头指示的前提下，有权、也必须按具体情况主持其认为合理的抢救手术，不得延误抢救时机。4、新技术、新项目、科研手术（1）一般的新技术、新项目手术及重大手术、致残手术须经科内讨论，科主任在已填写的重要手术审批单上签署同意意见后，上报医务科，由医务科备案并审批。（2）高风险的新技术、新项目、科研手术由医院上报省卫生厅审批。必要时由省卫生厅委托指定的学术团体论证、并经专家委员会评审同意后方能在医院实施。5、需要向医务科报告或审批的手术。（1）该学科新开展或高难度的重大手术。（2）邀请国内外著名专家参加的手术。（3）预知预后不良或危险性很大的手术。（4）可能引起医疗纠纷的手术或存在医疗纠纷的再次手术。（5）国家邀请的外宾、港澳台知名人士的手术。（6）干部病人（省、市、校领导，省内外知名人士）的手术。（7）可能导致毁容或致残的手术。（8）大器官移植手术。以上手术，须经科内讨论，科主任签字同意后报医务科备案，手术科室科主任负责审批。6、外出会诊手术本院执业医师受邀请到外单位或外地手术，必须按执业医师法、医师外出会诊管理规定的要求办理相关审批手续。外出手术医师所主持的手术不得超出其在本细则规定的相应手术级别。 七、行政管理1、为了确保医疗安全，根据医师职称承担的责任，实行各级医师分级手术制度。各手术科室应执行各级医师手术范围的规定，带组教授或科室主任根据规定审批参加手术的术者和助手名单。手术医师在提升手术级别时，由科主任及带组教授实行具体考核，并以“术前小结”审批经过中签字盖章生效。2、手术按照已确定的手术人员分工进行，不得越级手术。手术中根据病情需要扩大手术范围，或改变预定术式，需请示上级医师，按照医师分级手术范围规定进行手术。如施行越级手术时，需经科主任批准并必须有上级医师在场指导。3、除正在进行的手术术者向上级医师请示外，上级医师不得未经给病人会诊，未参加术前讨论，未办理手术手续，而直接参加手术。4、新技术、新项目、科研手术必须征得患者或直系家属的知情同意，并签署知情同意告知书。对违反本规范超权限手术的科室和责任人，一经查实，将追究科室和责任人的责任；对由此而造成医疗事故的，追究相应人员责任。明确各级医师手术权限，是规范医疗行为，保障医疗安全，维护病人利益的有力措施，各手术科室及各级医师必须严格遵照执行。 八、手术分级标准妇 科一级手术1.扩宫和刮宫术2.输卵管通气、通液术3.后穹窿穿刺4.外阴、宫颈活体组织采取术5.外阴良性肿物切除、前庭大腺囊肿手术6.经阴道有蒂子宫肌瘤摘除术7.宫颈息肉摘除术、宫颈赘生物电切术8.宫颈电灼术、冷冻术及激光治疗术二级手术1. 子宫切除术、子宫及附件切除术2. 腹腔镜下附件手术3. 经腹子宫肌瘤剜出术4. 子宫内膜异位症手术5.简单尿瘘修补术6.后穹隆切开术7.附件切除术8.异位妊娠手术三级手术1. 尿瘘、粪瘘修补术2. 一般宫腔镜手术3. 阔韧带肌瘤、囊肿切除术4. 单纯外阴切除术5. 子宫脱垂悬吊术或经阴道修补术6. 盆腔脓肿清除引流术7. 子宫扩大、广泛、次广泛切除术8. 外阴广泛性切除及腹股沟淋巴结清扫术9. 复杂子宫内膜异位症10.宫颈肌瘤切除术四级手术1. 盆腔清扫术2. 联合盆腔脏器切除术3. 新技术新项目手术4. 复杂卵巢癌、绒癌根治术5. 外阴阴道成形术6. 外阴重建术7. 腹腔镜下子宫切除术产 科一级手术1. 会阴侧切及会阴侧切缝合术2. 会阴、度裂伤修补术3. 古典式剖宫产术4. 引产术5. 胎头吸引术6. 常规助产二级手术1. 子宫裂伤修补术2. 臀位牵引术3. 人工胎盘剥离术4. 臀位助产术5.低颈剖宫产术6.古典剖宫产术三级手术1. 腹膜外剖宫产2. 剖宫产子宫切除术3. 晚期妊娠子宫破裂手术4. 毁胎术5.产钳术6.剖宫产子宫肌瘤核除术7.妊娠合并卵巢蒂扭转8.附件切除术、肿瘤切除术四级手术1. 重危手术2. 新技术新项目手术3. 会阴度裂伤修补术4. 子宫翻出复位术5.妊娠合并症（心脏病、甲亢、血液系统疾病等）6.剖宫产术生殖医学科一级手术1. 宫内节育器放置术2. 宫内节育器取出术3. 输卵管通气、通液术4. 人工流产吸刮术5. 腹部输卵管结扎术6. 羊水穿刺术7. 绒毛采取术二级手术1. 输卵管吻合术2. 输卵管造口术3. 输卵管成形术4. 人工授精三级手术1. 阴道输卵管结扎术2. 输卵管子宫内移植术3. 腹腔镜下取卵术4. 剖腹取卵+输卵管配子移植术5. 腹腔镜下取卵+输卵管配子移植术四级手术1. 吻合血管的自体输卵管移植术2. 同种异体输卵管移植术3. 卵巢移植术4. 新技术新项目手术妇产科四级手术：(1)子宫体癌根治术(2)卵巢癌根治术(3)腹腔镜诊断与经宫腹腔镜手术(4)各种疑难阴道内式手术(瘘管修补、阴道畸形整形等)(5)各种人工阴道成形术(6)各种难产的复杂手术(7)诊断不明确的探查术(8)新开展的各种手术(9)宫颈癌根治术(10)阴道内子宫切除术(11)有严重合并症的产科及妇科各种手术(12)外阴癌根治术(13)腹膜外剖宫术(14)阴道B超介导下取卵术，减胎术三级手术：(1)复杂子宫全切手术(2)单纯性外阴切除术(3)碎胎术、穿颅术(4)阴道成形术(5)阔韧带内肿瘤手术(6)三度会阴裂伤缝合术(7)宫腔镜、阴道镜技术的应用(8)显微外科输卵管吻合术(9)子宫内膜异位症的手术(10)子宫肌瘤剔除术(11)附件全切术(12)产后阴道大血肿切开缝合术二级手术：(1)子宫全切术(2)子宫肌瘤剜除术(3)古典式剖宫产手术、子宫下段剖宫产术(4)宫外孕手术(5)二度会阴裂伤缝合术(6)有异常的人流、取环术(7)附件切除术(8)前庭大腺囊肿手术(9)无痛人流(10)中期妊娠引产术(11)异常驻环位的取环术(12)输卵管造新术(13)无痛人流一级手术：(1)宫颈活检(2)上环、取环、人流术、药流(3)胎头吸引术(4)人工剥离胎盘术(5)臀位牵引术(6)前庭腺脓肿切开引流术(7)处女膜切开术(8)二度以下会阴裂伤缝合术(9)会阴侧切缝合术(10)宫颈炎的各种物理治疗(电、激光、微波、冷冻等)(11)输卵管通液粘查术(12)诊断性括宫术(13)巴氏腺囊肿切开术参与本物业的竣工验收，并在物业移交接管时，与甲方办理物业管理书面交接手续；本物业交付使用后的质量标准.说课标就是要把课程标准中的课程目标（三维目标）作为本课题教学的指导思想和教学依据，从课程论的高度驾驭教材和指导教学设计。Grass-roots governance according to law is an important foundation for promoting the construction of rule of law, but also the most basic development environment. Despite my good social order in General, but there are law-abiding consciousness, social order is not standard, regardless of faith, Twining visit visit and other outstanding problems. We want to actively promote the field of multi-level governance according to law, promote the continuous improvement of the social environment. To promote universal compliance. Actively foster the rule of law culture, carry out law publicity and education on honesty and trustworthiness, guide the masses and consciously abide by the law, failing to find method, problem-solving method, method of gradually changing the world, he is not looking for but someone unspoken rules, formed all law law, abide by the good atmosphere. To strengthen the comprehensive management of public security. Deepening peace xingan construction, strongly against violence crime, mafia and serious criminal offences, to protect the legitimate rights and interests of citizens, legal persons, carry out criminal policy of temper justice with mercy, the maximum stimulating social vitality, and earnestly safeguard social harmony and stability. To resolve social conflicts by law. To further smooth channels of reporting social conditions and public opinion, improving regulation, arbitration, as well as dispute resolution mechanisms, implement fully the petitioners cases third-party hearings and supervising system of letters and calls, and to resolve the involved law lawsuit into the orbit of rule of law, vexatious, Twining visit visit, disturbing social order and other malicious extortion, resolutely crack down. Five, improving cadres Vitale, provide strong protection for forest development XI General Secretary stressed that the comprehensive revitalization in Northeast China, needs a high quality, solid style, cadres of the dare to play. Cadre cadres is a pledge, should want to do work and able to do good, enthusiasm is paramount. Treat party cadres, it is necessary to Strict management, and warm care, enable the broad masses of cadres work hard work, this is two parallel principles. In strict accordance with the standards of good cadres selection and appointment, the real officers, dare officers, those who want to play, good as excellent cadres at all levels of leadership in the past. At present, some leading cadres work initiative is not high, beyond political, idle, lazy governance governance, not as, slow, messy and a phenomenon still exist to varying degrees, affected and restricted economic and social development. We must mobilize the enthusiasm of cadres as an urgent task, adhere to combination of incentives and constraints, and adhere to the strict management and warm care, practical solution for the officers not to problem, motivate cadres and better lead the masses to an undertaking, the cadres and create the new achievement in a dare to play, good at shows as new. To identify the problem, accurate pulseof law to visit and contribute to make visits to the vexatious visits arrogance. On these issues, we need to have a proper understanding, should take the lead to establish a sense of fear of the law, strengthen the application of the rule of law and the rule of law work of thinking and take up responsibility for the construction of the rule of law. Put learning first. Premise is ignorant of the law, abide by the law. Leading cadres at all levels should take the lead in studying the Constitution and laws and regulations closely related to work assumed by, an accurate grasp of the basic position of our party to address the issue of the rule of law, known for the scale to do things, figure out how to use it right, what things do, what not to do,