达芬奇机器人辅助低位直肠前切除术的卫生经济学评价

Health economic evaluation of Leonardo's robot-assisted lower anterior rectectomy

目的:本研究旨在调查福建省达芬奇机器人辅助手术开展情况,对达芬奇机器人辅助低位直肠前切除术与腹腔镜辅助低位直肠前切除术进行对比作卫生经济学方面的评价,为临床医师和患者及其家属选择达芬奇机器人辅助手术提供参考。方法:本研究根据福建省某医院筛选出的达芬奇机器人辅助低位直肠前切除术与腹腔镜辅助低位直肠前切除术病例,运用数据分析法系统比较分析达芬奇机器人组和腹腔镜组患者的基本情况、医疗安全、短期疗效、住院时间、住院费用等方面的指标差异。运用卫生经济学评价方法对纳入研究的患者住院费用的绝对值和相对值进行对比分析。结果:达芬奇机器人组手术时长比腹腔镜组平均长89.61 min,总费用平均高出30334.13元,差异有统计学意义(P<0.05);术中出血量、术后住院时间、手术并发症等手术安全性指标差异均无统计学意义(P>0.05);手术并发症发生率、严重并发症发生率、术后排气时间、术后进入ICU比例等短期疗效指标差异均无统计学意义(P>0.05)。结论:(1)达芬奇机器人辅助手术时间长于腹腔镜辅助手术;(2)达芬奇机器人辅助手术术中出血量和腹腔镜组相当;(3)达芬奇机器人辅助和腹腔镜辅助手术同样安全有效;(4)达芬奇机器人辅助和腹腔镜辅助手术的住院时间差异无统计学意义;(5)达芬奇机器人辅助手术的住院费用高于腹腔镜辅助手术的住院费用;(6)达芬奇机器人和腹腔镜辅助手术的费用构成基本相同;(7)达芬奇机器人对术者方面有很大优势。

Objective:To investigate the development of Leonardo's robot-assisted surgery in Fujian Province,to compare Leonardo's robot-assisted lower anterior rectectomy with laparoscopic-assisted lower anterior rectectomy in terms of health economics,and to provide reference for clinicians,patients and their families to choose Leonardo's robot-assisted surgery.Methods:Some cases of Leonardo's robot-assisted lower anterior rectectomy and laparoscopic-assisted lower anterior rectectomy from a hospital in Fujian Province were chosen,with the differences in basic conditions,medical safety,short-term curative effects,hospitalization time and hospitalization expenses between the two group compared by using the system analysis method and the absolute and the relative values of hospitalization expenses of patients compared by using the method of health economic evaluation.Results:The operation time of the Leonardo's robot group was 89.61min longer than that of the laparoscopic group,and the total cost was 30,334.13 yuan higher than that of the laparoscopic group,the difference being significant(P<0.05).There was no significant difference in intraoperative blood loss,postoperative hospital stay and surgical complications.There was no significant difference in short-term curative effect indexes such as the incidence of surgical complications,the incidence of serious complications,the time of postoperative exhaust and the proportion of postoperative admission to ICU.Conclusion:(1)The operation time of the Leonardo's robot group is longer than that of the laparoscopic group.(2)The amount of bleeding of the Leonardo's robot group was similar to that of the laparoscopic group.(3)The Leonardo's robot-assisted surgery is as safe and effective as the laparoscopic assisted surgery.(4)There was no significant difference in hospital stay between the Leonardo's robot-assisted surgery and the laparoscopic-assisted surgery.(5)The hospitalization cost of the Leonardo's robot-assisted surgery is significantly higher than that of the laparoscopic-assisted surgery.(6)The cost composition of the Leonardo's robot-assisted surgery and laparoscopic assisted surgery is basically the same.(7)The Leonardo's robot-assisted surgery is more beneficial to the surgeons.