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目的分析腹腔镜直肠癌根治术的费用构成,与开放手术进行比较,探讨腹腔镜直肠癌的费用控制方法。方法2007年10月～2008年6月腹腔镜直肠癌手术42例,与同期开放直肠癌手术52例进行经济学对照研究,分析两组住院期间主要费用构成,影响费用的主要因素,分析腹腔镜手术组的学习曲线过程中费用的变化。结果腹腔镜组行前切除[含低位前切除(Dixon)]31例,腹会阴联合切除(Miles)11例(含Hartmann2例);开放组52例中前切除38例,腹会阴联合切除14例(含Hartmann3例)。腹腔镜组Dixon手术平均费用26459.6元,Miles手术平均费用24901.4元;开放组住院费用分别为26097.4元和21690.3元;Dixon手术组间比较,腹腔镜组在手术费用和治疗费用高于开放组,而开放组药费支出高于腹腔镜组(P<0.05);在学习曲线过程中腹腔镜手术的费用逐渐下降。结论腹腔镜组直肠癌患者的费用可控制在与开放手术类似的水平,腹腔镜直肠癌根治的费用随着学习曲线的完成会逐渐下降。
Objective To analyze the cost constitution of laparoscopic radical resection of rectal cancer and compare with the open operation and discuss the cost control method of laparoscopic rectal cancer. Methods From October 2007 to June 2008, 42 cases of laparoscopic rectal cancer surgery and 52 cases of open rectal cancer surgery during the same period were compared with each other. The main cost components during the hospitalization and the main factors affecting the cost were analyzed. Changes in the cost of learning curve in the surgery group. Results In the laparoscopic group, 31 cases underwent anterior resection [including Dixon], 11 cases underwent perineal resection (including 2 cases with Hartmann), 52 cases underwent anterior resection in 38 cases, 14 cases underwent abdominal perineal resection (Including Hartmann3 cases). The average cost of Dixon operation in laparoscopic group was 26459.6 yuan and the average cost of Miles operation was 24901.4 yuan. The cost of hospitalization in open group was 26097.4 yuan and 21690.3 yuan respectively. In laparoscopic group, laparoscopic group had higher operation cost and treatment cost than open group, The expenses of the open group were higher than those of the laparoscopic group (P <0.05). The cost of laparoscopic surgery decreased gradually during the learning curve. Conclusions The cost of laparoscopic rectal cancer patients can be controlled at a similar level to that of open surgery. The cost of laparoscopic radical resection of rectal cancer will decrease gradually with the completion of the learning curve.