日间腹腔镜胆囊切除术的优势

目的探讨日间腹腔镜胆囊切除术（ambulatory laparoscopic cholecystectomy，ALC）的可行性、安全性及患者满意度，并进行卫生经济学评价。方法 回顾性分析笔者所在医院2011年4月至2012年12月期间分别行ALC及住院腹腔镜胆囊切除术（in．patient laparoscopic cholecystectomy，IPLC）患者的临床资料，其中IPLC组1 534例，ALC组678例。比较2组的手术时间、中转开腹率、术后并发症率、住院时间、住院费用、再入院率及患者满意度。结果2组的手术时间、术后并发症率和再入院率比较差异均无统计学意义p＞0．05）；ALC组中转开腹率（0．44％）和住院时间[（1．2±0．5）叫显著低于或短于IPLC组[3．19％，（4．8±1．3）dJ，P〈0．05；ALC组直接费用为（6 555．6±738．7）元、间接费用为（230．0±48．0）元、总费用为（6 752．0±424．3）元，显著低于IPLC组的（7 863．7±1 014．6）元、（973．0±136．5）元和（8 856．0±636．0）元（P〈0．05）。结论ALC是安全可行的，能缩短住院时间及降低医疗费用，加快床位周转，提高医疗卫生资源的利用。

The Advantage of Ambulatory Laparoscopic Cholecystectomy

Objective To investigate the feasibility, safety, cost, and patient satisfaction of ambulatory laparo- scopic cholecystectomy （ALC）. Methods The clinical data of patients who divided into ALC group （678 cases） and in-patient laparoscopic cholecystectomy （IPLC） group （1 534 cases） in our hospital from April 2011 to December 2012 were retrospectively analyzed. The operative time, conversion rate, complication rate, hospitalization time, cost of hospi- talization, rehospitalization rate, and patient satisfaction were analyzed and evaluated. Results There were no significant differences of the operative time, postoperative complication rate, and rehospitalization rate between the 2 groups （P〉 0. 05）. The conversion rate （0. 44%）, and hospitalization time [（1.2±0. 5） d] of the ALC group were significantly lower or shorter than those of IPLC group [ 3. 19%, （4.8±1.3） d], P〈0. 05. The direct, indirect health care costs, and the total costs of the ALC group were （6 555.6±738.7）, （230.0±48.0）, and （8 856.0±636.0） yuan, respec- tively; and lower than those of the IPLC group [ （7 863.7±1,014.6）, （973.0± 136.5）, and （8 856.0±636.0） yuan], P〈0.05. Conclusion ALC is safe and feasible, and could shorten the hospitalization time, lower the medical cost, speed up the bed tumover, and increase the effciency in the use of health resource.