输卵管妊娠腹腔镜与开腹手术治疗对比研究及其卫生经济学价值分析

Comparative study on laparoscopic surgery and laparotomy in treatment of tubal pregnancy and value analysis of medical economics

目的探讨腹腔镜手术治疗输卵管妊娠的疗效并评价其应用的卫生经济学价值。方法收集该院妇科2009年1月-2014年9月961例输卵管妊娠患者的临床资料,其中腹腔镜手术组453例,开腹手术组508例,回顾性分析2组手术时间、术后14 d血β-h CG转阴、术中出血量、术后排气时间、术后住院日数、直接住院费用及间接住院费用。结果腹腔镜组手术时间(42.7±25.5)min、术中出血量(40.5±10.6)ml、术后排气时间(10.5±4.1)h、术后住院日数(5.18±2)d,开腹手术组手术时间(65.5±35.4)min、术中出血量(80.3±9.7)ml、术后排气时间(33.4±23.6)h、术后住院日数(7.32±3.1)d,2组有统计学差异(P<0.05);腹腔镜手术组术后14 d血β-h CG转阴与开腹组无统计学差异(P>0.05);腹腔镜组直接住院费用(14 482.8±1 959)元明显高于开腹手术组直接住院费用(10 396±4 509)元,P<0.05,但腹腔镜组总费用(19 876.2±931.2)元与开腹手术组总费用(19 901.7±915.7)元比较无统计学差异(P>0.05)。结论应用腹腔镜行输卵管妊娠手术效果优于开腹手术,且总费用与开腹手术相同,腹腔镜手术可以作为治疗输卵管妊娠的首选。

Objective To explore the curative effect of laparoscopic surgery in treatment of tubal pregnancy, evaluate the value of medical economics. Methods The clinical data of 961 patients with tubal pregnancy were collected from Department of Gynecology in the hospital from January 2009 to September 2014, then the patients were divided into laparoscopic surgery group （453 patients） and laparotomy group （508 patients） ; the operation time, the negative conversion rates of blood β-human chorionic gonadotropin （[3-hCG） after 14 days of treatment, the amounts of blood loss during operation, postoperative exhausting time, postoperative hospitalization days, direct hospitalization expenses, and indirect hospitalization expenses in the two groups were analyzed retrospectively. Results The operation time, the amount of blood loss during operation, postoperative exhausting time, and postoperative hospitalization days in laparoscopic surgery group were （42.7± 25.5） minutes, （40. 5±10. 6） ml, （ 10. 5±4. 1 ） hours, and （5.18±2） days, respectively; the operation time, the amount of blood loss during operation, postoperative exhausting time, and postoperative hospitalization days in laparotomy group were （65.5 ± 35.4） minutes, （80. 3±9. 7） ml, （33.4±23.6） hours, and （7.32±3. 1 ） days, respectively, there were statistically significant differences between the two groups （P〈0. 05 ） ; there was no statistically significant difference in the negative conversion rate of blood 13-hCG after 14 days of treatment between the two groups （P〉0. 05 ） ; the direct hospitalization expense in laparoscopic surgery group was （ 14 482. 8±1 959） Yuan, which was statistically significantly higher than that in laparotomy group [ （ 10 396±4 509 ） Yuan] （P〈0. 05 ）, but there was no statistically signifi- cant difference in the total hospitalization expense between laparoscopic surgery group [ （19 876. 2±931.2） Yuan ] and laparotomy group [ （ 19 901.7±915.7） Yuan] （P〉0. 05） . Conclusion The effect of laparoscopic surgery is superior to laparotomy in treatment of tubal pregnancy, the total hospitalization expenses of the two methods are the same, laparoscopic surgery can be used as the first choice for treating tubal pregnancy.