开腹与腔镜子宫全切术的卫生经济学比较研究

A Comparative Study of Health Economics Between Total Laparoscopic and Open Hysterectomy for Patients with Hysteromyoma

目的:比较子宫肌瘤患者分别接受腹腔镜子宫全切术或开腹子宫全切术的手术过程和医疗资源消耗,为医护和患者选择合适的手术方式提供依据,也为医保报销规则制定提供参考依据。方法:采集2020年12月至2021年9月在四川大学华西二院因患子宫平滑肌瘤而需要接受子宫全切术的患者,共173例患者,其中99例(57.23%)患者接受腹腔镜经腹子宫全切术(微创手术,LTH组),74例(42.77%)患者接受开腹子宫全切术或开腹筋膜外子宫全切术(传统开腹手术,TOH组),对两组患者的术中出血量(mL)、手术用时(min)、总住院天数(day)、医疗总费用(￥)、耗材耗占比(%)和药占比(%)等指标进行统计分析,P<0.05则认为有组间显著性差异。结果与结论:子宫肌瘤患者接受腹腔镜子宫全切术比接受传统开腹手术花费的手术时间更短,术中出血量更少,消耗的医疗资源也更少。

Objective:The aim of this study is to compare the operation process and medical expenses of patients with hysteromyoma undergoing total laparoscopic hysterectomy or total open hysterectomy,and provide evidence and advice for clinical doctors and patients with hysteromyoma to make more appropriate decisions.The study results also help medical insurance departments to formulate reimbursement rules.Methods:173 patients who were diagnosed as hysteromyoma and needed to undergo hysterectomy in West China Second Hospital of Sichuan University from December 2020 to September 2021 were analyzed,of which 99(57.23%)patients underwent total laparoscopic hysterectomy(TLH group),and 74(42.77%)patients underwent total open abdominal hysterectomy or total open extra-fascial hysterectomy(traditional open operation,as TOH group).Statistical analysis was used to compare the blood loss in operation(ml),operation time cost(min),the time of hospital stay(day),total medical expense(￥),the proportion of material expenses(%)and drug expenses(%)between these two groups.Results&Conclusion:Patients with hysteromyoma undergoing total laparoscopic hysterectomy have a shorter operation time,less blood loss,and consume less medical resources than traditional total open hysterectomy.