开腹与腹腔镜全子宫切除手术效果研究

目的 比较不同级别医疗机构中良性子宫病变患者采取开腹全子宫切除术(TAH)与腹腔镜全子宫全切术(TLH)的手术效果,指导患者选择就诊.方法 回顾性分析846例因子宫良性病变进行TAH和TLH患者的临床资料,分别比较两种术式在二级和三级医院中的临床效果和医疗费用、住院天数等指标.结果 两种术式患者术前基本特征一致,与TLH相比,TAH手术时间较短(P＜0.01)、出血量较多(P＜0.01)、全身麻醉率低(P＜0.01),并发症少(P＜0.05)、直接医疗费用低(P＜0.01),但住院时间长(P＜0.05);二级和三级医院手术的效果接近,但二级医院直接医疗费用明显低于三级医院(P＜0.05).结论 TAH和TLH在所调查医院具有相似的手术结局,手术本身各具优缺点,但具有相同手术指征的患者选择二级医院完成手术成本的效果更优.

Study on the Effects of Total Abdominal Hysterectomy and Total Laparoscopic Hysterectomy

Objective To evaluate the effects of treating benign uterine diseases with total abdominal hysterectomy (TAH) and total laparoscopic hysterectomy (TLH) in different hospitals,and to guide the patients for treatment.Methods By reviewing the clinical data of 846 cases with benign uterine diseases treated by TAH and TLH,the clinical effects,medical costs,and hospital stay in the secondary and tertiary hospitals were compared.Results TAH had shorter operation times (P<0.01),more bleeding (P<0.01),less proportion of general anesthesia (P<0.01),less complications (P<0.05),less direct medical costs (P<0.01) and longer hospital stay (P<0.05) than those of TLH.There were similar effects of both operations between the two levels of hospitals and less direct medical costs in the secondary hospitals than that in the tertiary hospitals.Conclusion Both TAH and TLH have their advantages and disadvantages in the surveyed hospitals.It is more cost-effective for patients with the same operative indications to choose the secondary hospital than choosing the tertiary hospital.