胸腔镜和开胸肺切除手术费用的比较分析

Cost analysis for two approaches of pulmonary resection:thoracoscopy and thoracotomy

目的：比较分析胸腔镜和开胸肺切除术病人的住院总费用和药费。方法：同一医院同期完成的胸腔镜和开胸肺切除手术病人，其中胸腔镜组１７ 例，开胸组２０ 例，术后均无严重并发症。结果：胸腔镜肺切除术的住院总费用和药费的平均值均低于常规开胸组，但差异无显著性，其中药费〔（７２４６ ．５３ ±８７８ ．８７）元对（１４７６４ ．７５ ±１３０１ ．８４） 元〕差异有极显著性（ Ｐ＜ ０ ．００１） 。结论：胸腔镜肺切除手术和常规开胸术在住院总费用上没有显著差别。只要通过技术改进，降低手术费用，胸腔镜手术将会在我国得到更广泛的应用。

Aim:The disposable instrument and video equipment used in video-assisted thoracic surgery(VATS)are comparatively expensive .This study is to estimate whether VATS pulmonary resection is much more expensive than thoracotomy in China.Methods:This study included 17 patients with pulmonary resection by VATS and 20 through thoracotomy at one hospital during a three-year period.Hospital charges were obtained from records,and the total charges and costs associated with drugs and surgery in both groups were analyzed and compared.Results:No hospital deaths and severe postoperative complications occurred in both groups.The average total hospital costs were reduced in the VATS group (average cost:VATS,$21198,thoracotomy,$25073,P=0.07),and the average cost of drugs in VATS group was much lower than thoracotomy($7246 vs $14764,P<0.001).Conclusions:The disposable instrument charges were higher for the VATS approach,but a shortened hospital stay and a less antibiotic used for the VATS procedure result in a comparable total cost. Additional benefits,such as less postoperative pain,earlier return to work and several other potential advantages,make thoracoscopic lung resection a valuable treatment method.