深部浸润型子宫内膜异位症手术患者的卫生经济学分析

目的:研究深部浸润型子宫内膜异位症手术治疗的住院费用、住院时间、术后住院时间及其影响因素。方法:通过查阅2000年1月至2009年12月在北京协和医院登记且经手术证实为深部浸润型子宫内膜异位症的病例,比较不同年龄(≤30岁,31～40岁,>40岁)、不同时期(2000～2004年,2005～2009年)、不同病理分型(单纯型,穹窿型和直肠型)、不同手术路径(开腹手术和腹腔镜手术)、不同手术方式(保守和根治/半根治手术)、合并其他类型内异症等不同因素类别的平均住院费用、平均住院时间和平均术后住院时间,分析这些因素对住院费用和住院时间的影响。结果:总计615例深部浸润型内异症患者纳入研究。深部浸润型内异症患者的平均住院费用显著高于其他内异症病例(8181元vs 7713元,P=0.009),但是平均年龄、平均住院时间和平均术后住院时间却显著小于其他内异症病例(分别为34.3岁vs 37.6岁,5.7天vs 6.3天以及3.7天vs 4.3天,P均<0.001)。在众多影响因素中,仅不同手术方式之间的平均住院费用有显著统计学差异(P<0.001),保守手术费用最低,根治性手术费用最高。平均住院时间和平均术后住院时间受到多种因素影响,多因素分析显示,手术路径、手术方式和病理分型的影响最大(P均<0.001),腹腔镜手术、保守手术和单纯型的平均住院时间最短,开腹手术、根治手术和直肠型的平均住院时间最长。结论:手术路径、手术方式和病理分型是影响深部浸润型内异症手术治疗所需住院费用和住院时间的最重要的因素。

Economic analysis on the surgery of deep infiltrating endometriosis: a review of cases from Peking Union Medical College Hospital in recent ten years

Objective：To study hospital expenses,hospital stay and post-operative stay of surgical management on deep infiltrating endometriosis（DIE）.Methods：The average hospital expenses and average hospital stay were compared in all the DIE cases registered in Peking Union Medical College Hospital（PUMCH）and confirmed by surgery from Jan.2000 to Dec.2009 between all kinds of possible affecting factors：different ages（≤30 years,31~40 years,and 40 years）,different eras（2000~2004 years,2005~2009 years）,pathologic types（simple DIE,vaginal DIE and rectal DIE）,surgical approaches（laparoscopy and laparotomy）,surgical categories（conservative,semi-radical and radical surgery）,complication of other variety of endometriosis（peritoneal,ovarian endometriosis and adenomyosis）.Factors affecting on surgical economics were analyzed.Results：A total of 615 patients with integrated records received surgeries on DIE.The average hospital expenses of DIE patients were significantly higher than other variety of endometriosis（RMB 8181 vs 7713,P=0.009）,while the average age,hospital stay and post-operative stay of DIE patients were significantly lower than other variety of endometriosis（34.3 vs 37.6 years,5.7 vs 6.3 days,and 3.7 vs 4.3 days respectively,all P0.001）.There was significant difference of hospital expenses only among different surgical categories（P0.001）：conservative surgery had the lowest cost,while radical surgery had the highest one.There were many factors affecting hospital stay and post-operative stay.In multi-factor analysis model,surgical approaches,surgical categories and pathologic types were the most influential factors（all P0.001）：laparoscopic,conservative surgery and simple DIE had the shortest hospital stay and post-operative stay,while the laparotomic,radical surgery and rectal DIE and the longest ones.Conclusion：Surgical approaches,surgical categories and pathologic types affected the hospital expenses,hospital stay and post-operative stay significantly.