腹腔镜胆囊切除术与传统开腹胆囊切除术的成本-效用分析  

Cost-utility Analysis of Laparoscopic Cholecystectomy and Open Cholecystectomy

作　　者：覃潇茗 向前[2] 周杰[3] 许军[2] 张翔[1] 

机构地区：[1]南方医科大学人文与管理学院,广东省广州市510515 [2]南方医科大学南方医院卫生经济管理科 [3]南方医科大学南方医院肝胆外科

出　　处：《中国全科医学》2014年第33期3938-3943,共6页Chinese General Practice

基　　金：广东省科技计划项目(2012B031800304)

摘　　要：目的探讨行腹腔镜胆囊切除术和传统开腹胆囊切除术患者的生存质量,并进行成本-效用分析。方法收集2014年1—5月南方医科大学南方医院患胆囊结石伴胆总管结石,需要择期行胆囊切除并行胆总管探查手术的患者47例,根据手术方式分为:开腹组20例,腹腔镜组27例,选择胃肠疾病生存质量指数(GIQLI)量表和简明健康状况测量量表(SF-36)测定患者在术前、术后2周和术后6周健康相关的生存质量及其获得的净效用值(Δu),并进行成本-效用分析。结果开腹组与腹腔镜组术前、术后2周、术后6周GIQLI量表评分及其中的自觉症状、躯体生理功能、心理情绪状况、社会活动评分比较,差异均无统计学意义(P>0.05);两组术前、术后2周特殊疾病状况评分比较,差异均无统计学意义(P>0.05);术后6周腹腔镜组特殊疾病状况评分高于开腹组(P<0.05)。开腹组术后2周躯体生理功能评分较术前降低,术后6周躯体生理功能、心理情绪状况评分较术前升高(P<0.05)。腹腔镜组术后6周GIQLI量表评分及其中的自觉症状、躯体生理功能、心理情绪状况、社会活动、特殊疾病状况评分较术前升高(P<0.05)。开腹组与腹腔镜组术前、术后2周、术后6周SF-36评分及其中的心理维度、生理机能、精力、社会功能、情感职能、精神健康评分比较,差异均无统计学意义(P>0.05);开腹组术前生理维度、生理职能、一般健康状况评分较腹腔镜组降低(P<0.05);开腹组术后6周躯体疼痛评分较腹腔镜组降低(P<0.05)。开腹组术后2周生理维度、生理机能评分较术前降低,躯体疼痛评分较术前升高;术后6周生理维度、生理职能、躯体疼痛评分较术前升高(P<0.05)。腹腔镜组术后2周生理维度、生理机能、生理职能、情感职能评分较术前降低,躯体疼痛评分较术前升高;术后6周SF-36评分及其中的生理维度、心理维度、躯体疼痛、一般健康状况�Objective To discuss the quality of life of patients after laparoscopic cholecystectomy and traditional open cholecystectomy and to compare their cost- utility. Methods 47 patients with cholecystolithiasis and choledocholithiasis admitted to Nanfang Hospital of Southern Medical University from January to May in 2014 were collected,and they were all in need of cholecystectomy. The patients were divided into open cholecystectomy group（ 20 cases） and laparoscopic cholecystectomy group（ 27 cases）. Health-related quality of life（ QoL） and utility scores（ Δu） before operation,two weeks and six weeks after operation were assessed by the Gastrointestinal Quality of Life Index（ GIQLI） and the Short Form 36（ SF- 36）,and the cost- utility analysis was also performed. Results The scores of GIQLI and its scores of subjective symptom,physical function,emotional status and social activity between the open cholecystectomy group and the laparoscopic cholecystectomy group showed no statistically significant difference before operation,two weeks and six weeks after operation（ P〉 0. 05）. The scores of special illness conditions between two groups two weeks after operation showed no statistically significant difference（ P〉 0. 05）. The score of special illness condition of laparoscopic cholecystectomy group was higher than that of the open cholecystectomy group six weeks after operation（ P〈 0. 05）. The score of physical function two weeks after operation was lower than that before operation,but six weeks after operation,the scores of physical function and emotional status were higher than those before treatment（ P〈 0. 05）.The scores of GIQLI and its scores of subjective symptom,physical function,emotional status,social activity and special illness condition in the laparoscopic cholecystectomy group six weeks after operation were higher than those before treatment（ P〈 0. 05）.The scores of SF- 36 and its scores of psychological dimension,physical function,energy,social function,emot

关 键 词：胆囊切除术 腹腔镜 胆石 成本-效用分析 

分 类 号：R575.621[医药卫生—消化系统]