腹腔镜下异位妊娠手术的卫生经济学研究

目的:比较和分析腹腔镜与开腹异位妊娠手术的效果和成本。方法:用回顾性队列研究方法比较2006年6月至2006年12月我院施行腹腔镜与开腹异位妊娠手术患者的临床资料,手术效果,总成本及其构成(包括直接医疗费用、直接非医疗费用和间接费用)。其中腹腔镜手术60例,开腹手术30例。结果:(1)腹腔镜组输卵管保留率高,手术时间短,术中出血少,术后康复快,镇痛率低、尿管拔除早、下地早、通气早、体温恢复正常快、抗生素应用时间短、住院天数短、恢复工作早;各项指标与开腹组比较均有显著差异(P<0.01);(2)总住院费用腹腔镜组为(4877.42±496.68)元,高于开腹组的(4365.48±626.19)元(P<0.001);腹腔镜组的直接非医疗费用为(325.83±58.58)元,误工费为(1058.80±149.04)元,低于开腹组的(395±75.83)元和(1761.77±192.70)元(P<0.001);各项相关费用总计,腹腔镜组为(6262.05±551.35)元,与开腹组的(6522.25±668.20)元差异未达显著性水平(P=0.053)。结论:腹腔镜下异位妊娠手术患者术后康复快,腹腔镜下异位妊娠手术并不比开腹手术成本高,甚至比开腹手术更经济。

Health economics of treatment of ectopic pregnancy by laparoscopy and laparotomy

Objective:To compare the effects and the costs of ectopic pregnancy treated by laparoscopy and laparotomy.Methods:Patients with ectopic pregnancy who treated by laparoscopy or laparotomy in Urumqi Military General Hospital from Jun. 2006 to Dec. 2006 were selectively enrolled to perform a retrospective cohort study.Results:The patients who underwent laparoscopy enjoyed a higher oviduct reservation rate,a quicker operation,a less blood loss and a better recovery (P<0.01).The cost of hospitalization was higher in laparoscopy(4877.42±496.68)yuan vs.(4365.48±626.19)yuan(P<0.001).But the nonmedical expenditure and the salary loss of off work days were significantly lower in the laparoscopy group than in the laparotomy group.The total cost of laparoscopy(6262.05±551.35)yuan seems to be lower than that of laparotomy(6522.25±668.20)yuan.But the difference didn't reach significant level(P=0.053).Conclusions:The patients who underwent laparoscopy enjoy a better recovery.According to the mean income level of employees in Urumqi,there is no significant difference in the total cost among two groups.