小儿腹腔镜胆囊切除术的效果,安全性和费用分析

ANALYSIS OF THE EFFICIENCY,SAFETY AND COST OF LAPAROSCOPIC CHOLECYSTECTOMY IN CHILDREN

目的 :分析腹腔镜胆囊切除术 (LC)在儿外科实践的效率。方法 :回顾性研究两所儿童医疗中心开展儿童LC(1 993年 3月～ 2 0 0 0年 5月 )的效果 ,安全性和费用材料。统计分析用Student’st检验。结果 :1 1 8例胆囊切除术中 ,32例OC(2 7% ) ,86例LC(73 % )中 ,3例中转OC(3 .5 % )。手术时间LC =96 .3min与OC =96 .7min ,P >0 .0 5。住院时间LC比OC减少 2 .8d ,P <0 .0 5。两组均无手术技术并发症。LC总费用与OC比较没有明显增加 ,LC是 (30 4 2 9± 897)元与OC是 (30 2 4 5± 6 842 )元 ,P =0 .91。结论 :LC应用于儿童安全而有效。LC明显缩短了住院时间。经过培养的医生做LC ,不会增加并发症。与OC比较 。

Objective:To analyze the effect of introducing LC in pediatric surgical practice. To compare the clinical aspects, safety and costs of LC with open cholecystectomy (OC). Methods:Authors retrospectively reviewed all cases of cholecystectomy (LC & OC) performed since the introduction of LC eight years ago. Institutional setting:two referral medical centers for a population of 4.5 million. Variables analyzed included operating time, surgical expertise, contraindications to LC, complications, hospital stay and cost using students t test.Results:Of the 32 OC performed (14 with concomitant splenectomy), 7 had significant common duct stones. Five of the 86 LC had undergone previous upper abdominal surgery. There were 3 elective conversions in the LC group. Operating time was similar in both groups (LC=96.7 min. vs. OC=96.3 min). There was no significant difference in complications (LC=4.7% vs. OC=6%). Hospital stay was reduced by 2.8 days in the LC cases (LC=2.01.6 vs. OC=4.83.6, P <0.05). Total cost of LC is not significantly higher than OC (LC=30,429±897 yuan RMB vs. OC= 34,327 ±6783 yuan RMB, P =0.91).Conclusions:A widespread usage of LC was noted in recent years. The introduction of LC into general pediatric surgical practice has been safe and effective. Hospital stay is reduced without an increase in major complications. Age of child or the previous abdominal surgeries was not contraindications for LC. The LC did not significantly increase the cost compared with OC because it shortened the mean length of hospital stay and didn't increase the operating cost with using reusable instruments.