江苏省某医院行机器人胃癌根治术的卫生经济学研究

Health economics research on robot-assisted radical gastrectomy for gastric cancer in a hospital in Jiangsu Province

目的分析实施机器人援助胃癌根治术的患者费用及术后康复情况,对江苏省某医院行达芬奇机器人援助胃癌根治术与传统开放手术、腹腔镜下胃癌根治术进行卫生经济学评价。方法以2020年7月1日至2021年7月31日江苏省某中医院普外科行胃癌根治术的患者113例为研究对象,根据手术方式分为3组:达芬奇机器人援助胃癌根治术组(n=46)、开放手术组(n=26)、腹腔镜下胃癌根治术组(n=41),对3组手术患者的费用、费用结构及术后康复指标进行比较分析。结果1)机器人组与开放手术组、腹腔镜组在总费用、药品费(尤其是西药费)、手术耗材费、诊疗服务费、检验检查费方面差异有统计学意义(P<0.05);机器人组药品费用降幅最大,差异有统计学意义(P<0.05)。2)机器人组通气时间(3.02±0.33)d、通便时间(4.00±0.29)d、首次经口摄食时间(1.80±0.36)d、拔除尿管时间(0.78±0.61)d及术后住院天数(5.72±0.70)d大幅度提前(P<0.05);术后并发症发生率差异无统计学意义(P>0.05)。3)机器人组与开放手术组患者的自付金额差异有统计学意义(P<0.05)。结论达芬奇机器人援助手术能显著降低患者药品费,大幅度缩减病人住院时间,且与开放手术、腹腔镜技术同样安全有效,新医改背景下实施达芬奇机器人外科手术,可以提升医疗服务质量,节约医疗卫生资源。

Objective To analyze the cost and postoperative rehabilitation of patients with gastric cancer undergoing robot-assisted therapy,and to evaluate the health economics of Da Vinci robot-assisted radical gastrectomy,traditional gastrectomy and laparoscopic-assisted radical gastrectomy in a hospital in Jiangsu Province.Methods One hundred and thirteen patients who underwent radical gastrectomy for gastric cancer in the general surgery department of Jiangsu Hospital of Traditional Chinese Medicine from July 1,2020 to July 31,2021 were selected as the study subjects,and were divided into 3 groups according to surgical methods:the robot-assisted laparoscopic radical gastrectomy for gastric cancer group(n=46),the traditional gastrectomy group(n=26),and the laparoscopic radical gastrectomy group(n=41).The cost,cost structure and postoperative rehabilitation indexes of the three groups of patients were compared and analyzed.Results 1)There were significant differences in the total cost,drug cost,especially Western medicine cost,surgical consumables cost,diagnosis and treatment service cost,and inspection cost between the robot group and the open surgery group and the laparoscopic group(P<0.05).The decrease of drug cost in the robot group was the largest,and the difference was statistically significant(P<0.05).2)In the robot group,the ventilation time(3.02±0.33)d,defecation time(4.00±0.29)d,first oral feeding time(1.80±0.36)d,catheter removal time(0.78±0.61)d and postoperative discharge days(5.72±0.70)were significantly advanced(P<0.05).There was no significant difference in the incidence of postoperative complications(P>0.05).3)There was a statistically significant difference in out-of-pocket payment between the robot group and the traditional surgery group(P<0.05).Conclusion Da Vinci robot-assisted radical gastrectomy significantly reduced the drug cost of patients,greatly reduced hospital stay and achieved rapid recovery,and was as safe and effective as traditional surgery and laparoscopic techniques.It is inevitable and necessary to implement Da Vinci robotic surgery under the background of the new medical reform,which could improve the quality of medical services and save medical and health resources.