腔镜与开放食管癌手术的住院费用比较  

Analysis of hospitalization expenses of the different esophagectomy

作　　者：游宾[1] 侯生才[1] 胡滨[1] 郭杰[1] 李辉[1] 

机构地区：[1]首都医科大学附属北京朝阳医院胸外科,100020

出　　处：《中华胸心血管外科杂志》2013年第6期358-361,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨微创食管癌手术的医学经济学特点及解决措施。方法回顾性分析微创及开放食管癌手术治疗的病例资料，对影响住院总费用的相关因素做单因素分析。再将相关因子做为自变量，对住院费用进行多元回归分析。结果单因素分析结果表明：术前合并内科疾病、住院天数、手术方式和术后并发症是影响住院费用的主要因素。多元线性回归分析显示，按影响因素对住院费用的作用，由大到小排序为术后并发症（β=0．439，P=0．000）、住院天数（β=0．397，P=0．000）、合并内科疾病（β=0．257，P=0．000）以及手术方式（β=0．132，P=0．023）。且微创手术的手术费用（62092元，P=0．000）及其在住院总费用中所占比例（P=0．000），均高于开放手术，差异有统计学意义。结论全腔镜食管癌切除术费用高于开放手术，但术后并发症等因素对住院费用的影响更大。微创食管手术的前景在于更好的发挥微创优势，减少并发症，缩短住院天数，从而体现更好的医学经济学效益。Objective To explore economic valuation of the minimally invasive esophagectomy. Methods The cases undergone esophagectomy were studied retrospectively. Monofactorial analysis was done to evaluate the impact of various factors on the overall hospitalization costs. The correlatod factors then were used as independent variables to carry out the multiple llne- ar regression aimed at the hospitalization costs. Results The results of monofactorial analysis showed that the accompanying diseases, days during hospitalization, modes of esophagectomy, postoperative complications were correlated factors of the overall hospitalization costs. According to the multiple linear regression, it were sorted based on descending order duing to its effect of largenning the hospitalization costs ： postoperative complications （~ = 0. 439, P = 0. 000 ）, days during hospitalization （ fl = 0. 397, P =0. 000）, accompanying diseases（fl =0. 257, P =0. 000）, modes of esophagectomy（~8 =0. 132, P =0. 000）. The expenses caused immediately by the operations were statistically more of the minimally invasive surgery than that of the open procedures whatever the numerous or proportion of the overall costs（ P =0. 000）. Conclusion Combined thoracoscopic and faparoacopic esophagectomy was more expensive than open operation. Nevertheless, impact of the other factors, such as postop- erative complications, were more significant than that of the different procedure. It was a strategy to minimally invasive esoph- ageetomy that hospitalization costs could be reduced by means of controlling complications and diminishing hospitalization days.

关 键 词：食管肿瘤 外科手术 微创性 费用 医疗 

分 类 号：R735.1[医药卫生—肿瘤]