CAJ | 학술논문

目的：比较显微镜手术与非显微镜手术治疗椎管内髓外硬膜下肿瘤的卫生经济学状况，探究显微镜手术是否增加椎管内髓外硬膜下肿瘤治疗成本，以了解显微镜手术和非显微镜手术治疗的卫生经济学差异。方法收集整理2010年1月-2012年6月53例行显微镜手术治疗和69例行非显微镜手术治疗的椎管内髓外硬膜下肿瘤患者的临床资料，显微镜手术有2种术式：半椎板切除+肿瘤显微镜摘除术19例（A组）、全椎板切除肿瘤+显微镜摘除+椎弓根螺钉内固定术34例（B组）；非显微镜手术有3种术式：半椎板切除+肿瘤摘除术24例（C组）、全椎板切除+肿瘤摘除+椎弓根螺钉内固定术27例（D组）、全椎板切除+肿瘤摘除术18例（E组）。对比各组卫生经济学指标。结果5组家属误工时间比较，差异无统计学意义（P>0.05）；A组与C组患者住院时间、患者术后恢复时间、患者误工时间比较，差异均无统计学意义（P>0.05）；D组患者住院时间、患者误工时间长于B组（P<0.05）；E组患者术后恢复时间、患者误工时间长于B组（P<0.05）。A组非手术相关费用少于C组（P<0.05）；B组非手术相关费用、总费用少于D组（P<0.05）；B组手术相关费用、住院费用、总费用多于E组，非手术相关费用少于E组（P<0.05）。结论在全椎板切除+肿瘤摘除+椎弓根螺钉内固定术中，显微镜手术总费用比非显微镜手术少。但在半椎板切除+肿瘤摘除术中，显微镜手术和非显微镜手术在总费用上未表现出明显差异。
목적：비교현미경수술여비현미경수술치료추관내수외경막하종류적위생경제학상황，탐구현미경수술시부증가추관내수외경막하종류치료성본，이료해현미경수술화비현미경수술치료적위생경제학차이。방법수집정리2010년1월-2012년6월53례행현미경수술치료화69례행비현미경수술치료적추관내수외경막하종류환자적림상자료，현미경수술유2충술식：반추판절제+종류현미경적제술19례（A조）、전추판절제종류+현미경적제+추궁근라정내고정술34례（B조）；비현미경수술유3충술식：반추판절제+종류적제술24례（C조）、전추판절제+종류적제+추궁근라정내고정술27례（D조）、전추판절제+종류적제술18례（E조）。대비각조위생경제학지표。결과5조가속오공시간비교，차이무통계학의의（P>0.05）；A조여C조환자주원시간、환자술후회복시간、환자오공시간비교，차이균무통계학의의（P>0.05）；D조환자주원시간、환자오공시간장우B조（P<0.05）；E조환자술후회복시간、환자오공시간장우B조（P<0.05）。A조비수술상관비용소우C조（P<0.05）；B조비수술상관비용、총비용소우D조（P<0.05）；B조수술상관비용、주원비용、총비용다우E조，비수술상관비용소우E조（P<0.05）。결론재전추판절제+종류적제+추궁근라정내고정술중，현미경수술총비용비비현미경수술소。단재반추판절제+종류적제술중，현미경수술화비현미경수술재총비용상미표현출명현차이。
Objective To compare the results of health economics between microsurgery and non - microsurgery treat-ment of the intradural extramedullary tumor in the spinal canal,to investigate whether the treatment cost of microsurgery is higher than that of non - microsurgery. Methods 53 patients with intradural extramedullary tumor in the spinal canal who underwent the microsurgery and 69 patients with intradural extramedullary tumor in the spinal canal who underwent the non - microsurgery from January 2010 to June 2012,were selected as study subjects,the medical records of whom were collected. There were two kinds of surgical procedures for the microsurgery group,19 cases in group A underwent hemilaminectomy + tumor microscopic excision, 34 cases in group B underwent laminectomy + tumor microscopic excision + pedicle screw fixation. Meanwhile,there were three kinds of surgical procedures for the non - microsurgery group:24 cases in group C underwent hemilaminectomy + tumor exci-sion,27 cases in group D underwent laminectomy + tumor excision + pedicle screw fixation,18 cases in group E underwent laminectomy + tumor excision. The health economics indicators were compared among different groups. Results There was no significant difference in the downtime of family member of patients among 5 groups(P > 0. 05). There was no significant differ-ence in the duration of hospital stays,postoperative recovery time and the downtime of patient between group A and group C(P> 0. 05). The duration of hospital stays and the downtime of patient in group D were significantly longer than those in group B(P< 0. 05). The postoperative recovery time and the downtime of patient in group E were significantly longer than those in group B (P < 0. 05). The expenses associated with non - surgery in group A were significantly less than those in group C(P < 0. 05).The expenses associated with non - surgery and the total expenses in group B were significantly less than those in group D(P <0. 05). The expenses associated with surgery,the hospitalization expenses and the total expenses in group B were significantly more than those in group E,the expenses associated with non - surgery in group B were signrficantly less than those in group E (P < 0. 05). Conclusion In the laminectomy + tumor excision + pedicle screw fixation,the total expense of the microsurgery is lower than that of non - microsurgery. But in hemilaminectomy + tumor excision,there is no significant difference in the total expense between microsurgery and non - microsurgery.