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目的:比较腹腔镜和开腹直肠前切除术两种手术技术的费用以及卫生资源利用率。方法:将2003年1月至2005年5月我院收治的直肠癌病人前瞻性非随机分为腹腔镜组(87例)和开腹组(86例)。前瞻性比较两组的一般资料、手术资料、术后并发症料、直接与间接医疗费用以及直接医疗费用的构成。直接医疗费用包括手术材料费用、治疗药品费用、输血费用、住院费用、高能营养费用及处理术后并发症费用;间接医疗费用(病人和家属的误工费用)以误工天数乘以日平均收入计算。结果:腹腔镜组与开腹组直接医疗费用分别为26787.00(5036.00)元和24865.50(7422.00)元,两组无统计学差异;其中手术费用腹腔镜组为20332.17(1364.00)元,显著高于开腹组的7234.00(1793.29)元(P<0.01);药物治疗费用腹腔镜组3021.00(1364.00)元,显著低于开腹组的7234.00(4147.00)元(P<0.01);住院床位费用腹腔镜组为584.64(260.18)元,显著低于开腹组为834.24(389.21)元(P<0.01);两组的输血费用、高能营养费、处理术后并发症费用无明显差异。两组直接医疗费用的构成:腹腔镜组手术费、药品费和住院费分别69.07%、14.76%和2.18%,开腹组分别为45.43%、36.47%和3.35%。间接医疗费用腹腔镜组为1206.02(666.64)元,显著低于开腹组的2071.58(1071.21)(P<0.01)。结论:相对于开腹直肠前切除术,腹腔镜手术可通过减少药品费用、住院费用,缩短住院天数,加快床位周转,使卫生资源利用率更高,且能达到更低的间接医疗费用。
Objective: To compare the cost of two surgical techniques for laparoscopic and open anterior rectal resection and the utilization of health resources. METHODS: Patients with rectal cancer admitted to our hospital from January 2003 to May 2005 were prospectively and nonrandomly divided into laparoscopic group (87 cases) and laparotomy group (86 cases). Prospectively compare the general data, surgical data, postoperative complications, direct and indirect medical expenses, and direct medical expenses of the two groups. Direct medical expenses include surgical material costs, medication costs, blood transfusion costs, hospitalization costs, high energy nutritional costs, and postoperative complications costs; indirect medical costs (patients and family members’ lost labor costs) are calculated by multiplying the number of lost days by the daily average income. Results: The direct medical expenses of laparoscopic group and laparotomy group were 26787.00 (5036.00) yuan and 24865.50 (7422.00) yuan respectively. There was no statistical difference between the two groups. The laparoscopic group cost was 20332.17 (1364.00) yuan, which was significantly higher than that of open surgery group. In the abdominal group, 7234.00 (1793.29) yuan (P<0.01); the cost of drug treatment was 3021.00 (1364.00) yuan in the laparoscopic group, which was significantly lower than the 7234.00 (4147.00) yuan in the laparotomy group (P<0.01); the cost of hospital bed laparoscopic group It was 584.64 (260.18) yuan, which was significantly lower than that of the open group (834.24 (389.21) yuan (P<0.01); there was no significant difference in blood transfusion costs, high-energy nutritional fees, and postoperative complications costs between the two groups. The composition of direct medical expenses in the two groups was 69.07%, 14.76% and 2.18% in the laparoscopic group, and 45.43%, 36.47% and 3.35% in the open group, respectively. The cost of indirect medical care in the laparoscopic group was 1206.02 (666.64) yuan, which was significantly lower than that in the laparotomy group (2071.58 (1071.21) (P<0.01). Conclusion: Compared to open anterior rectal resection, laparoscopic surgery can reduce the cost of medicines and hospitalization costs, shorten the length of hospital stay, speed up the turnover of beds, make the utilization rate of health resources higher, and can achieve lower indirect medical expenses.