中国全科医学
中國全科醫學
중국전과의학
CHINESE GENERAL PRACTICE
2014年
33期
3938-3943
,共6页
覃潇茗%向前%周杰%许军%张翔
覃瀟茗%嚮前%週傑%許軍%張翔
담소명%향전%주걸%허군%장상
胆囊切除术,腹腔镜%胆石%成本 - 效用分析
膽囊切除術,腹腔鏡%膽石%成本 - 效用分析
담낭절제술,복강경%담석%성본 - 효용분석
Cholecystectomy,laparoscopic%Gallstones%Cost - utility analysis
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、精力、精神健康评分较术前升高（P <0.05）。开腹组直接成本和总成本〔（43585.95±9609.27）元和（47581.71±9833.89）元〕均高于腹腔镜组〔（23435.53±13293.19）元和（26391.92±1367.44）元〕（ P <0.05）；两组间接成本〔（3989.77±3048.75）元与（2956.39±1768.59）元〕比较，差异无统计学意义（P >0.05）。开腹组成本-效用比采用 GIQLI量表评分评判为37793.26，采用 SF -36评分评判为43652.94；腹腔镜组成本-效用比采用 GIQLI 量表评分评判为26391.92，采用 SF -36评分评判为29990.82。结论腹腔镜胆囊切除术是一种低成本高效用产出的手术方式。
目的：探討行腹腔鏡膽囊切除術和傳統開腹膽囊切除術患者的生存質量，併進行成本-效用分析。方法收集2014年1-5月南方醫科大學南方醫院患膽囊結石伴膽總管結石，需要擇期行膽囊切除併行膽總管探查手術的患者47例，根據手術方式分為：開腹組20例，腹腔鏡組27例，選擇胃腸疾病生存質量指數（GIQLI）量錶和簡明健康狀況測量量錶（SF -36）測定患者在術前、術後2週和術後6週健康相關的生存質量及其穫得的淨效用值（Δu），併進行成本-效用分析。結果開腹組與腹腔鏡組術前、術後2週、術後6週 GIQLI 量錶評分及其中的自覺癥狀、軀體生理功能、心理情緒狀況、社會活動評分比較，差異均無統計學意義（P >0.05）；兩組術前、術後2週特殊疾病狀況評分比較，差異均無統計學意義（P >0.05）；術後6週腹腔鏡組特殊疾病狀況評分高于開腹組（P <0.05）。開腹組術後2週軀體生理功能評分較術前降低，術後6週軀體生理功能、心理情緒狀況評分較術前升高（P <0.05）。腹腔鏡組術後6週 GIQLI 量錶評分及其中的自覺癥狀、軀體生理功能、心理情緒狀況、社會活動、特殊疾病狀況評分較術前升高（P <0.05）。開腹組與腹腔鏡組術前、術後2週、術後6週 SF -36評分及其中的心理維度、生理機能、精力、社會功能、情感職能、精神健康評分比較，差異均無統計學意義（P >0.05）；開腹組術前生理維度、生理職能、一般健康狀況評分較腹腔鏡組降低（P <0.05）；開腹組術後6週軀體疼痛評分較腹腔鏡組降低（P <0.05）。開腹組術後2週生理維度、生理機能評分較術前降低，軀體疼痛評分較術前升高；術後6週生理維度、生理職能、軀體疼痛評分較術前升高（P <0.05）。腹腔鏡組術後2週生理維度、生理機能、生理職能、情感職能評分較術前降低，軀體疼痛評分較術前升高；術後6週 SF -36評分及其中的生理維度、心理維度、軀體疼痛、一般健康狀況、精力、精神健康評分較術前升高（P <0.05）。開腹組直接成本和總成本〔（43585.95±9609.27）元和（47581.71±9833.89）元〕均高于腹腔鏡組〔（23435.53±13293.19）元和（26391.92±1367.44）元〕（ P <0.05）；兩組間接成本〔（3989.77±3048.75）元與（2956.39±1768.59）元〕比較，差異無統計學意義（P >0.05）。開腹組成本-效用比採用 GIQLI量錶評分評判為37793.26，採用 SF -36評分評判為43652.94；腹腔鏡組成本-效用比採用 GIQLI 量錶評分評判為26391.92，採用 SF -36評分評判為29990.82。結論腹腔鏡膽囊切除術是一種低成本高效用產齣的手術方式。
목적：탐토행복강경담낭절제술화전통개복담낭절제술환자적생존질량，병진행성본-효용분석。방법수집2014년1-5월남방의과대학남방의원환담낭결석반담총관결석，수요택기행담낭절제병행담총관탐사수술적환자47례，근거수술방식분위：개복조20례，복강경조27례，선택위장질병생존질량지수（GIQLI）량표화간명건강상황측량량표（SF -36）측정환자재술전、술후2주화술후6주건강상관적생존질량급기획득적정효용치（Δu），병진행성본-효용분석。결과개복조여복강경조술전、술후2주、술후6주 GIQLI 량표평분급기중적자각증상、구체생리공능、심리정서상황、사회활동평분비교，차이균무통계학의의（P >0.05）；량조술전、술후2주특수질병상황평분비교，차이균무통계학의의（P >0.05）；술후6주복강경조특수질병상황평분고우개복조（P <0.05）。개복조술후2주구체생리공능평분교술전강저，술후6주구체생리공능、심리정서상황평분교술전승고（P <0.05）。복강경조술후6주 GIQLI 량표평분급기중적자각증상、구체생리공능、심리정서상황、사회활동、특수질병상황평분교술전승고（P <0.05）。개복조여복강경조술전、술후2주、술후6주 SF -36평분급기중적심리유도、생리궤능、정력、사회공능、정감직능、정신건강평분비교，차이균무통계학의의（P >0.05）；개복조술전생리유도、생리직능、일반건강상황평분교복강경조강저（P <0.05）；개복조술후6주구체동통평분교복강경조강저（P <0.05）。개복조술후2주생리유도、생리궤능평분교술전강저，구체동통평분교술전승고；술후6주생리유도、생리직능、구체동통평분교술전승고（P <0.05）。복강경조술후2주생리유도、생리궤능、생리직능、정감직능평분교술전강저，구체동통평분교술전승고；술후6주 SF -36평분급기중적생리유도、심리유도、구체동통、일반건강상황、정력、정신건강평분교술전승고（P <0.05）。개복조직접성본화총성본〔（43585.95±9609.27）원화（47581.71±9833.89）원〕균고우복강경조〔（23435.53±13293.19）원화（26391.92±1367.44）원〕（ P <0.05）；량조간접성본〔（3989.77±3048.75）원여（2956.39±1768.59）원〕비교，차이무통계학의의（P >0.05）。개복조성본-효용비채용 GIQLI량표평분평판위37793.26，채용 SF -36평분평판위43652.94；복강경조성본-효용비채용 GIQLI 량표평분평판위26391.92，채용 SF -36평분평판위29990.82。결론복강경담낭절제술시일충저성본고효용산출적수술방식。
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 oper-ation 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 statisti-cally 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,emotional function and mental health between the open cholecystectomy group and the laparoscopic cholecystectomy group showed no statistically sig-nificant difference before operation,two weeks and six weeks after operation(P > 0. 05). The scores of physiological dimension, physical function and general health status in the open cholecystectomy group were lower than those of the laparoscopic cholecys-tectomy group(P < 0. 05). The score of body pain of the open cholecystectomy group was lower than that of the laparoscopic cholecystectomy group six weeks after operation(P < 0. 05). Two weeks after operation,the scores of physiological dimension and physical function of the open cholecystectomy group were lower than those before treatment,but the pain degree was higher than that before treatment;six weeks after operation,the scores of physiological dimension,physical function and pain degree were higher than those before treatment(P < 0. 05). Two weeks after operation,the scores of physiological dimension,physical function,physical role and emotional role of the laparoscopic cholecystectomy group were lower than those before operation,but the score of pain degree was higher;six weeks after operation,the scores of SF - 36 and its scores of physiological dimension, psychological dimension,pain degree,general health status,energy and mental health were higher than those before treatment (P < 0. 05). The direct cost and total cost of the open cholecystectomy group〔(43 585. 95 ± 9 609. 27)and(47 581. 71 ± 9 833. 89)〕were higher than those of the laparoscopic cholecystectomy group〔(23 435. 53 ± 13 293. 19)and(26 391. 92 ± 1 367. 44)〕(P < 0. 05). The indirect cost of the two groups〔(3 989. 77 ± 3 048. 75)and(2 956. 39 ± 1 768. 59)〕showed no statistically significant difference(P > 0. 05). The cost - utility ratio of the open cholecystectomy group was 37 793. 26 and 43 652. 94 by GIQLI and SF - 36 respectively. The cost - utility ratio of the laparoscopic cholecystectomy group was 26 391. 92 and 29 990. 82 by GIQLI and SF - 36 respectively. Conclusion Laparoscopic cholecystectomy is an operation method with a low cost and high utility.
