三种不同全子宫切除术式对患者围手术期生活质量的影响和卫生经济学研究

目的 观察经腹全子宫切除术(TAH)、腹腔镜下全子宫切除术(LH)和经阴道全子宫切除术(TVH)3种不同术式对患者围手术期生活质量的影响和卫生经济学研究。方法 应用世界卫生组织生活质量测定量表简表,对3组(TAH组,19例;LH组,20例;TVH组,13例)患者分别在术前、术后第4天、术后第14天和术后第28天进行生活质量评估;以术前和术后28 d内门诊和(或)急诊就诊医药费,住院费用,门诊和(或)急诊就诊、住院和术后恢复期间,患者和家人工作岗位上收入的损失和门诊和(或)急诊就诊、住院和术后恢复期间,与手术相关的、支付他人的佣金等4方面计算手术总费用;以术前和术后28 d内,在门诊和急诊就诊次数以及住院天数,计算对卫生资源的消耗。结果(1)术后第4天生活质量评分,TVH组为(93±6)％,LH组为(85±10)％,TAH组为(81±11)％,TVH组与TAH组比较,差异有极显著性(P<0.01);术后第14天生活质量评分,TVH组为(95±7)％,LH组为(96±7)％,TAH组为(85±9)％;术后第28天生活质量评分,TVH组为(96±10)％,LH组为(98±7)％,TAH组为(87±10)％;TVH组及LH组组间比较,差异均无显著性,但与TAH组比较,差异均有显著性(P<0.01、P<0.01)。(2)术前和术后28 d内,门诊和急诊就诊医药费,TVH组为(838±211)元,高于LH组的(583±50)元和TAH组的(568±31)元;

Effect of different surgical approaches on quality of life and cost-consequence

OBJECTIVE: To evaluate the effects of total abdominal hysterectomy (TAH), laparoscopic hysterectomy (LH) and transvaginal hysterectomy (TVH) on quality of life, cost and health care utilization. METHODS: A study of women who underwent elective hysterectomy was performed to assess the effect of operations on quality of life using WHO quality of life-bref before operation, at the 4th, 14th and 28th day after operation, respectively. The data of total cost and health care utilization were also analyzed. RESULTS: The score of quality of life at the 4th day after operation in TVH patients was significantly higher than that in TAH patients (93 +/- 6 vs 81 +/- 11, P < 0.01). There was no significant difference in this score between TVH and LH, and between LH and TAH patients. However, at the 14th and 28th after operation, the scores in both TVH and LH patients were significantly higher than that in TAH patients (95 +/- 7 and 96 +/- 7 vs 85 +/- 9, P < 0.001 and 0.001; 96 +/- 10 and 98 +/- 7 vs 87 +/- 10, P < 0.01). There was no significant difference in the total costs among three groups. The better health care utilization was in LH and TVH patients, and the worse in TAH patients. CONCLUSIONS: The effect of LH and TVH on quality of life and health economics is similar, and appears to be superior than that of TAH.