两种不同手术路径治疗贲门癌的疗效和卫生经济学评价

Two different surgical paths of cardiac cancer and health economic evaluation

目的:比较经胸手工分层吻合和经胸器械吻合两种手术路径治疗贲门癌的临床疗效和所耗费用。方法:回顾性分析甘肃省肿瘤医院2013年10月至2014年9月行贲门癌根治手术且符合本研究要求的病例102例,分为经胸手工分层吻合组60例和经胸器械吻合组42例,对两组患者的术后并发症、疗效及医疗费用等指标进行比较。结果:经胸器械吻合组的术后吻合口狭窄显著高于经胸手工分层吻合组(P<0.05);在肺部感染、住院病死率、上下切缘阳性率、清扫淋巴结数目、胃食管反流症状方面没有统计学差异(P>0.05)。经胸器械吻合组医疗总费用高于经胸手工吻合组(P<0.05);成本最小化分析(CMA)示经胸手工吻合组成本显著低于经胸器械吻合组,差异有统计学意义(P<0.05)。对两组患者住院费用构成进行单因素分析,结果显示:经胸手工分层吻合组手术材料费及药品费占住院总费用为46.81%、26.34%,而经胸器械吻合组手术材料费及药品费占住院总费用分别为56.87%、19.95%。本结果提示两种手术治疗径路的临床近期疗效无显著差异,但经胸器械吻合组与经胸手工吻合组的总成本费用却存在较大差异(P<0.05),其中手术材料费用在两种方案中所占的比例分别为46.81%,56.87%,说明手术材料费用是手术路径选择的一个主要因素。结论:经胸手工分层吻合手术路径在贲门癌根治术中是一种有效、经济的方法,更加适用于卫生医疗资源相对欠发达的中西部医疗机构。

Objective： To compare the therapeutic effect and the cost of two surgical approaches,transthoracic which is artificial anastomosis and transabdominal which is stapling anastomosis, for cardiac carcinoma. Methods：The clinical data of 102 of cardiac carcinoma,60 are transthoracic and 42 are transabdominal, treated from September 2013 to October 2014 were analyzed retrospectively and compare the two groups in a variety of aspects,such as postoperative complication,therapeutic effect and cost. Results：The group of transabdominal is much higher than transthoracic in the aspect of postoperative hospital stay and anastomotic stricture（P〈0.05）;the group of stapling anastomosis has the advantage of postoperative pain,but the cost is higher;there is no statistic difference in pulmonary infection,hospital mortality,the positive rate of incisal margin,the number of lymph nodes dissected and gastroesophageal（P〉0.05）.CMA showed that the cost of transthoracic and the transabdominal in which have the differences statically significant（P〈0.05）. Single factor analysis of the cost showed that the total cost of the hospital and the medical expenses was 46.81%, 26.34%, and the total cost of medical equipment was 56.87% and 19.95%, respectively.We can concluled from the result that there no significant difference between the two surgical approaches in the aspect of effective rate of short-term treatment,however,the total cost have differences between the groups in each group the cost of opration materials account for 46.81%,56.87%,which showed the cost of opration materials is the mian factor to determine selection of surgical approach. Conclusion：Transthoracic which is artificial anastomosis is an effective and economical treatment for the cardiac carcinoma,which is more suitable for the central and western areas where medical resources and services are underdeveloped.