机器人与腹腔镜肝左外叶切除手术的经济学分析

Economic cost analysis of robotic versus laparoscopic left lateral segment liver resection

目的从经济学角度探讨机器人肝左外叶切除手术的可行性。方法回顾性分析2015年1月至2016年3月,在解放军总医院肿瘤外二科行机器人和腹腔镜肝左外叶切除手术的39例患者资料,其中机器人手术10例(机器人手术组),腹腔镜手术29例(腹腔镜手术组)。比较两组患者的年龄、性别、诊断、肿瘤直径等一般资料,以及平均手术时间、术后住院时间、手术费用、西药费用和住院总费用等。结果两组患者均顺利实施肝左外叶切除,无中转开腹且术后均未出现全身和局部并发症,围手术期未输血。两组的术后住院时间分别为(4.9±1.4)d和(4.4±1.4)d,两组比较,差异无统计学意义(P=0.502)。机器人手术组的手术时间为(124.2±22.7)min,明显长于腹腔镜手术组(76.4±22.0)min(P=0.010)。机器人手术组的住院总费用(7.61±0.86)万元,明显高于腹腔镜手术组(4.86±0.98万元)(P=0.001)。两组的手术费用分别为(3.32±0.29)万元和(1.57±0.16)万元(P=0.001)。两组的西药费用比较,差异无统计学意义(P=0.624)。结论选择传统腹腔镜手术还是选择机器人手术时,有必要进行成本效益分析并建立一套科学的评估系统。目前肝左外叶切除的手术方式仍以模式化的腹腔镜肝左外切除为首选。

Objective The purpose of this study was to compare the economic outcomes of robotic versus laparoscopic left lateral segment liver resection( LLS). Methods We retrospectively compared demographic and perioperative data as well as postoperative and economic outcomes of robotic(n=10) and laparoscopic(n=29) LLS performed between Jan. 2015 and Mar. 2016. The sex,age,diagnosis,tumor size,operation time,postoperative length of stay,total cost and cost of operated were collected both of the two groups. Results Demographic and tumor characteristics of robotic and laparoscopic LLS were similar.The blood transfusion,conversion to open and postoperative complications did not happen between both groups. The postoperative length of hospital stay of the robotic and laparoscopic group were respectively( 4. 9 ± 1. 4) d and( 4. 4 ± 1. 4) d( P=0. 502). There wasalso no significantdifference in the drug expense of the two groups. However, the operative time of the robotic and laparoscopic group were respectively( 124. 2 ± 22. 7) min and( 76. 4 ± 22. 0) min( P=0. 010). Additionally,the total costs of the robotic group was( 7. 61 ± 0. 86) ten thousand RMB,which was more expensive than the laparoscopic group( 4. 86 ± 0. 98) ten thousand RMB( P=0. 001). Moreover,the costs of the operation of the robotic and laparoscopic group were respectively( 3. 32 ± 0. 29) ten thousand RMB and( 1. 57 ± 0. 16) ten thousand RMB( P= 0. 001). Conclusions Although robotic LLS was comparable to laparoscopic LLS in surgical outcomes,robotic LLS was more expensive and time intensive. Thus,the laparoscopic LLS may be a good option for left lateral segment liver resection.