摘要
目的探讨子宫切除术的手术途径、主要适应证、卫生经济学指标及其变化。方法通过本院病案数据库,调用1996～2001年因良性妇科疾病在本院行子宫切除术的4180例患者的记录,根据手术方式,分为开腹、腹腔镜和阴式手术3组,对各组的手术适应证、住院天数、手术费用及总医疗费进行分析。结果三种途径子宫切除术所占比例为:开腹78.4%,腹腔镜13.0%,阴式8.6%;腹腔镜手术比例从1996年的2.4%上升到2001年的17.3%。子宫切除术的主要适应证为:子宫肌瘤(56.2%)、子宫肌腺症(12.2%)、卵巢良性肿瘤(9.2%)、生殖道脱垂(7.7%)、子宫内膜异位症(6.9%)、子宫内膜不典型增生(3.0%)、宫颈上皮内瘤变(2.0%)、其他(2.8%)。开腹和腹腔镜组手术适应证前两位均为子宫肌瘤和子宫肌腺症;阴式组主要手术适应证为生殖道脱垂,其次是子宫肌瘤。三种途径子宫切除术的住院天数分别为腹腔镜组(8.9±3.7)d,开腹组(11.0±4.9)d,阴式组(10.9±3.9)d;总医疗费腹腔镜组(7473.8±1464.8)元,开腹组(5666.6±1709.4)元,阴式组(5027.6±1067.0)元。结论经腹腔镜子宫切除的比例逐渐上升,其直接医疗成本高于开腹子宫切除,但平均住院日少于后者。腹腔镜子宫切除的适应证与开腹子宫切除接近,阴式子宫切除的适应证与前两者不同。
To examine the operative approaches,major indications,and medical economic parame -ters of the hysterectomy.Methods Data on hysterectomy performed due to benign gynecological disorders in Peking Union Medical College Hospital (PUMCH)from1996to2001were reviewed.The cases were classified into three groups according to the operative approaches:total abdominal hysterectomy (TAH),vaginal hysterectomy (VH),and laparoscopic assisted vaginal hysterectomy (LAVH).The major in dications,length of hospital stay,operative cost,and total medical cost were analyzed.Results Records of4180women who had hysterectomies in PUMCH were examined.Operations included TAH(78.4%),LAVH (13.0%),and VH (8.6%).The use of LAVH increased from2.4%in1996to17.3%in2001.The common indications for surgery included uterine leiomyoma (56.2%),adenomyosis(12.2%),benign ovarian tumor (9.2%),genital prolapse (7.7%),endometriosis(6.9%),atypical endometrial hyperplasia (3.0%),and cervical intraepithelial neoplasm(2.0%).The most common indications for TAH and LAVH were uterine leiomyomas and adenomyosis,whereas the most common indication for VH was genital prolapse,followed by uterine leiomyoma.The lengths of hospital stay in TAH,VH,and LAVH were(11.0±4.9)d,(10.9±3.9)d,and(8.9±3.7)d respectively.The total medical cost was(5666.6±1709.4)RMB Yuan for TAH,(5027.6±1067.0)RMB Yuan for VH,and (7473.8±1464.8)RMB Yuan for LAVH.Conclusions The use of LAVH has been increasing.Although the direct medical cost for LAVH is higher than that for TAH,its indirect benefit appeares superior to TAH.The major indications for LAVH and TAH are similar,whereas the indications for VH are different from those for TAH and LAVH.
出处
《中国医学科学院学报》
CAS
CSCD
北大核心
2003年第4期406-409,共4页
Acta Academiae Medicinae Sinicae
