经腹腹膜前与完全腹膜外腹股沟疝修补术的卫生经济学评价

目的比较经腹腹膜前补片植入术（transabdominal preperitoneal，TAPP）和完全腹膜外补片植入术（totally extraperitoneal，TEP）的疗效以及卫生资源利用率。方法回顾性分析我院2010年6月～2012年6月47例行腹腔镜腹股沟疝修补术（1aparoscopic inguinal hernia repair，LIHR）的临床资料，其中TAPP组27例（33侧），TEP组20例（29侧）。比较2组术后住院时间、并发症、复发、直接医疗成本、间接成本、成本效果比等指标。结果与TAPP组相比，TEP组麻醉费高1061元（850—1267元）vs．918元（730～1180元），Z=-2．153，P=0．031]，材料费用低2897元（901～3956元）vs．3213元（2556～9559元），Z=-2．109，P=0．035]，成本一效果比低8932．16元vs．9754．34元]。2组术后住院时间（3．4±1．0）dvs．（3．2±0．8）d，t=0．736，P=0．465]、并发症发生率0vs．5％（1／20），P=0．426]、复发率3．7％（1／27）VS．5％（1／20），P=0．675]无明显统计学差异。2组检查费用、药品费用、手术费用、床位费用、护理诊疗费用、间接成本、总成本无明显统计学差异（P〉0．05）。结论TAPP与TEP治疗成人腹股沟疝疗效相同；与TAPP相比，TEP通过减少材料费用提高卫生资源利用率。

A Cost-effectiveness Analysis of Transabdominai Preperitoneal and Total Extraperitoneal Laparoscopic Inguinal Hernia Repair

Objective To compare the effectiveness and utilization rate of health resources of transabdominal preperitoneal and total extraperitoneal laparoseopic inguinal hernia repair. Methods From June 2010 to June 2012, the clinical data of 47 cases of laparoscope inguinal hernia repair （LIHR） were analyzed retrospectively. Twenty seven cases underwent transabdominal preperitoneal （TAPP group） and twenty cases underwent totally extraperitoneal （TEP group）. The postoperative hospital stay, complications, recurrence rate, direct and indirect medical cost of operation, and cost/effectiveness were compared. Results Compared with the TAPP group, the TEP group had significantly higher cost of anesthetization 1061 （850-1267） RMB vs. 918 （730 - 1180） RMB, Z = -2. 153, P =0.031], lower cost of material cost2897（901-3956） RMB vs. 3213 （2556-9559） RMB, Z = -2. 109, P = 0. 035 ] and lower cost-effectiveness 8932. 16 RMB vs. 9754.34 RMB ]. There were no significant statistical differences between the two groups in postoperative hospital stay（3.4 ± 1.0）d vs. （3.2 ±0.8）d, t =0. 736, P =0.465], complication rate 0 vs. 1（5%）,P =0.426] and recurrence rate3.7% （1/27） vs. 5% （1/20）, P =0.675]. No significant difference could be found between the two groups in examination cost, medicine cost, operation cost, bed fee, indirect and total cost （P 〉 0.05）. Conclusion TAPP and TEP have similar effect in treating adult inguinal hernia and TEP has higher cost-effectiveness in material cost compared with TAPP.