腹腔镜早期宫颈癌手术的价值及卫生经济学评价被引量：20

Cost-effectiveness and outcome analysis of laparoscopic modity hysterectomy for cervical carcinoma in early stage

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摘要目的比较腹腔镜和开腹早期宫颈癌次广泛全子宫切除术的近期疗效及两种手术技术的费用以及卫生资源利用率。方法 2007年10月～2010年10月,选择早期宫颈癌患者64例,其中腹腔镜手术组35例,开腹手术组29例。比较两组的手术资料、直接与间接医疗费用以及总医疗成本。结果腹腔镜手术组术中出血量、术后通气时间、术后病率和住院天数明显少于开腹手术组,而手术耗时腹腔镜组长于开腹组,两组术后并发症差异无显著性。腹腔镜组与开腹组直接医疗费用分别为(18832.3±5914.2)和(19104.8±4275.0)元,两组差异无显著性;其中手术材料费用及麻醉费用腹腔镜组分别为(2153.1±307.8)及(1369.3±265.5)元,显著高于开腹组的(1669.3±209.2)及(1174.0±152.8)元(P<0.01);腹腔镜组直接非医疗费用为(627.1±207.7)元,低于开腹组(936.2±279.6)元(P<0.01);腹腔镜组间接费用为(906.5±301.1)元,低于开腹组(1359.4±406.0)元(P<0.01)。总的医疗成本两组无显著差别。结论相对于开腹早期宫颈癌次广泛全子宫切除术,腹腔镜手术具有创伤小,患者恢复快的优势,且不增加总的医疗成本。 [Objectives] To compare the outcomes of laparoscopic modity hysterectomy for cervical carcinoma in early stage and evaluate the cost-effectiveness of the two methods for cervical carcinoma.[Methods] From Dec.2007 to Dec.2010,35 patients with cervical carcinoma underwent laparoscopic modity hysterectomy,while 29 cases were submitted to open procedure.The early outcomes,the direct,indirect and the total costs of two groups were compared.[Results] Although the operation time of the laparoscopic was longer than that of the open group,the former had less volume of blooding as well as advantages on some post-operational aspects,for instance,the shorter post-operational gastrointestinal function recovery time,the lower rate of getting diseases and the less time of being in hospital.The direct cost of laparoscopic group was similar to that of open group [（18832.3±5914.2） RMB VS （19104.8±4275.0） RMB;P〈0.05].The operation and anesthesia related cost of the laparoscopic group was significantly higher than that of the open group [（2153.1±307.8） RMB VS （1369.3±265.5） RMB,（1669.3±209.2） RMB VS （1174.0±152.8） RMB;P0.01].The direct non medical expenditure and the indirect expenditure of laparoscopic group was significant lower than that of open group [（627.1±207.7） RMB VS （936.2±279.6） RMB,（P0.01）;and （906.5±301.1） RMB VS （1359.4±406.0） RMB respectively;P0.01].The total cost was not significantly different between two groups.[Conclusions] Laparoscopic modity hysterectomy for cervical carcinoma in early stage is minor in invasiveness and faster in recovery.The total economical burden for the patients is not significantly different between the laparoscopic and open groups.