小儿腹股沟斜疝及鞘膜积液日间手术疗效与卫生经济学评价  

Efficacy and health economic evaluation of day surgery for pediatric inguinal hernia and hydrocele

作　　者：王志伟 张黄成昊 姚桂萍 毛睿[2] 窦红昆 刘灵芝[3] 计凤鸣 夭志刚 严兵[1] Wang Zhiwei;Zhang Huangchenghao;Yao Guiping;Mao Rui;Dou Hongkun;Liu Lingzhi;Ji Fengming;Yao Zhigang;Yan Bing(Department of Urology,Kunming Children's Hospital,Children's Hospital Affiliated to Kunming Medical Uniersity,Yunnan Provincial Key Laboratory of Children's Major Diseases Research,Yunnan Provincial Clinical Medical Research Center of Children's Health and Diseases,Kunming 650103,China;Department of Information,Kunming Children's Hospital,Kunming 650103,China;Day Surgery Conter,Kunming Children's Hospital,Kunming 650103,China)

机构地区：[1]昆明市儿童医院、昆明医科大学附属儿童医院泌尿外科、云南省儿童重大疾病研究重点实验室、云南省儿童健康与疾病临床医学研究中心,昆明650103 [2]昆明市儿童医院信息科,昆明650103 [3]昆明市儿童医院日间诊疗中心,昆明650103

出　　处：《临床小儿外科杂志》2024年第10期910-917,共8页Journal of Clinical Pediatric Surgery

基　　金：云南省教育厅科学研究基金(2023J0295);云南省科技厅昆医联合专项-面上项目(202301AY070001—108)。

摘　　要：目的探讨小儿腹股沟斜疝和鞘膜积液日间手术的疗效及卫生经济学价值。方法本研究为回顾性研究, 收集昆明市儿童医院泌尿外科自2018年1月至2022年12月收治的小儿腹股沟斜疝及鞘膜积液4 094例作为研究对象。根据患儿在日间诊疗中心或泌尿外科病房手术治疗情况, 分为日间组(n=2 327)和住院组(n=1 767);根据病种将日间组分为腹股沟斜疝日间组(A组, n=870)和鞘膜积液日间组(C组, n=1 457), 将住院组分为腹股沟斜疝住院组(B组, n=777)和鞘膜积液住院组(D组, n=990)。将4个亚组配为2对(A组&B组、C组&D组), 比较两种手术模式下患儿一般资料、住院时间、住院费用、院内感染、满意度和术后并发症的差异, 并分析两种手术模式的成本、治疗效果指数(effect index, EI)和成本效果比(cost-effectiveness ratio, CER)。结果以上2对进行组内比较显示, 术后发生发热或呕吐、需医疗机构处理的切口渗血或感染、复发和对侧新发情况差异无统计学意义(P>0.05);A、B组年龄分别为(4.43±2.85)岁和(3.58±2.82)岁, C、D组的年龄分别为(3.84±1.96)岁和(3.48±2.03)岁, 差异均有统计学意义(P<0.05)。A、B组住院时间分别为(10.30±3.35)h和(62.80±23.97)h, C、D组住院时间分别为(10.12±4.53)h和(62.06±25.96)h, 差异均有统计学意义(P<0.05)。A、B组住院费用分别为(3 602.10±431.48)元和(5 226.22±585.93)元;C、D组住院费用分别(3 592.67±387.67)元和(5 234.48±666.73)元, 差异均有统计学意义(P<0.05)。A、B组的满意度评分分别为(89.50±4.95)分和(83.38±6.02)分, C、D组的满意度评分分别为(88.83±4.56)分和(84.26±5.77)分, 差异均有统计学意义(P<0.05)。A、B组直接医疗成本分别为(3 534.28±520.93)元和(5 372.72±785.06)元, C、D组直接医疗成本分别为(3 468.71±519.03)元和(5 299.55±795.16)元, 差异均有统计学意义(P<0.05)。A、B组间接成本分别为(63.99±20.09)元和(368.25±136.11)元, C、DObjective To explore the efficacy and health economic value of day surgery for pediatric in-guinal hernia and hydrocele at Kunming Children's Hospital over the past 5 years.Methods This retrospective study collected clinical data from 4094 pediatric patients with inguinal hernia and hydrocele treated at the Department of Urology,Children's Hospital Affiliated to Kunming Medical University from January 2018 to December 2022.The patients were divided into a Day Surgery Group(n=2327)and an Inpatient Group(n=1767)based on their treatment in the day surgery center or urology ward.The Day Surgery Group was further Inguinal Hernia Day Surgery(Group A,n=870)and Hydrocele Day Surgery Group(Group C,n=1457).The Inpa-tient Group was divided into Inguinal Hernia Inpatient Group((GroupB,n=777)andHydroceleInpatient Group(Group D,n=990).The two surgical modalities were compared in terms of general patient data,length of hospital stay,hospitalization costs,incidence of nosocomial infection,satisfactionand postoperative complica tions.Cost,effect index(EI),and cost-effectiveness ratio(CER)were also analyzed for both surgical modalities.Results In the intragroup comparisons,no statistically significant differences were found between the paired groups regarding postoperative fever or vomiting,incision bleeding or infection requiring medical treatment,recurrence,or new contralateral occurrence(P>0.05).The average age in Groups A and B was 4.43±2.85 years and 3.58±2.82 years,respectively,and in Groups C and D was 3.84±1.96 years and 3.48±2.03 years,respectively,with a statistically significant difference(P<0.05).The average hospital stay was 10.30±3.35 hours for Group A and 62.80±23.97 hours for Group B,and 10.12±4.53 hours for Group C and 62.06±25.96 hours for Group D,with statistically significant differences(P<0.05).The average hospi-talization costs were 3602.10±431.48 yuan for Group A and 5226.22±585.93 yuan for Group B,and 3592.67±387.67 yuan for Group C and 5234.48±666.73 yuan for Group D,with statistically signific

关 键 词：腹股沟斜疝 鞘膜积液 卫生经济学 外科手术 儿童 

分 类 号：R47[医药卫生—护理学]