腹腔镜胰十二指肠切除术与同期开腹手术疗效与住院费用对比分析
安琳，张成，冯金鸽，安东均
摘 要
目的：探讨腹腔镜胰十二指肠切除术与同期开腹手术疗效与住院费用及影响因素，为医疗机构制定应对措施和医保报销政策提供依据。
方法：回顾性分析2017年1月1日～2018年12月31日某三甲医院出院的82例行胰十二指肠切除术患者的临床资料，根据手术入路分为腹腔镜组（LPD组，40例）和传统开腹组（OPD组，42例）。观察比较2组疗效和住院期间的各项费用发生情况及总费用。采用SPSS20.0软件进行统计分析。计数资料和率的比较采用 2x检验；正态分布的计量资料以
±s表示，采用t检验。经正态性检验，2组患者的住院各项费用均为偏态分布资料，故采用中位数进行描述分析，比较采用Wilcoxon符号秩和检验。以P＜0.05为差异有统计学意义。
结果：LPD组和OPD组手术前情况数据比较，P＞0.05，差异均无统计学意义，具可比性。住院时间比较（t=-1.526，P＜0.05）差异有统计学意义，LPD组＜OPD组。腹腔镜手术组的医用耗材费用高于现行的开腹手术组（P＜0.05），差异有统计学意义；腹腔镜手术组的西药费、床位费、检查费、治疗费、输血费等则低于现行的开腹手术组（P＜0.05），差异有统计学意义；2组护理费、化验费与手术费比较（P＞0.05），差异无统计学意义。总住院费用腹腔镜组低于现行的开腹组（P＜0.05），差异有统计学意义。
结论：LPD是安全可行的，较之OPD手术创伤小，术中出血少，术后恢复速度明显快于开腹手术。虽然医用耗材较高，但是住院总费用却明显少于开腹手术。随着微创外科技术的日益成熟，其耗材费用也会相应减少。
关键词
胰十二指肠切除术；腹腔镜外科；基本医疗保险；住院费用
Comparative Analysis of Curative Effect and Hospitalization Cost between Laparoscopic Pancreaticoduodenectomy and Simultaneous Open Surgery
AN Lin，ZHANG Cheng，FENG Jinge，AN Dongjun
（1.School of Statistics，Xi'an University of Finance and Economics，Xi'an 710100，China 2.Department of hepatobiliary surgery，the Center Hospital of xianyang City，Xi'an Jiaotong University Health Science Center，Xianyang，Shanxi 712000，China）Corresponding author:AN Lin，Email:AN Lin，3079027819@qq.com
ABSTRACT
Objective:To explore the curative effect，hospitalization expenses and influencing factors of laparoscopic pancreaticoduodenectomy and simultaneous laparotomy，so as to provide basis for medical institutions to formulate countermeasures and medical insurance reimbursement policies.
Methods:The clinical data of 82 patients with pancreaticoduodenectomy discharged from a 3A hospital from January 1，2017 to December 31，2018 were retrospectively analyzed.They were divided into laparoscopic group（LPD group，40 cases）and laparotomy group（OPD group，42 cases）according to the surgical approach.To observe and compare the curative effects of the two groups and the occurrence of various expenses and total expenses during hospitalization.SPSS20.0 software was used for statistical analysis.The comparison of counting data and rate adopts x2 test.The measurement data of normal distribution are expressed as
±s，and t-test.According to the normal test，the hospitalization expenses of the two groups of patients are skewed distribution data，so median is used for descriptive analysis and Wilcoxon sign rank sum test is used for comparison.The difference was statistically significant with P＜0.05.
Results:Compared with the preoperative data of LPD group and OPD group，P＞0.05，the difference is not statistically significant and comparable.The difference of hospitalization time（t=-1.526，P＜0.05）was statistically significant，LPD group＜OPD group.The cost of medical consumables in laparoscopic surgery group was higher than that in open surgery group（P＜0.05），and the difference was statistically significant.The western medicine fee，bed fee，examination fee，treatment fee and blood transfusion fee in the laparoscopic operation group were lower than those in the current open operation group（P＜0.05），and the difference was statistically significant.The total hospitalization cost in laparoscopic group was lower than that in open group（P＜0.05），and the difference was statistically significant.
Conclusion:LPD is safe and feasible.Compared with OPD，it has less trauma，less intraoperative bleeding，and faster postoperative recovery than laparotomy.Although medical consumables are relatively high，the total cost of hospitalization is significantly lower than that of laparotomy.With the development of minimally invasive surgery technology，the cost of consumables will be reduced accordingly.
KEY WORDS
Pancreaticoduodenectomy:Laparoscopic surgery；Basic medical insurances；Hospitalization expenses
微创外科与精准手术的开展，使得患者手术创伤小、痛苦少、疗效确切、恢复快，而获益颇丰，然而住院患者的医疗费用明显增加，因而也就限制了这些手术的应用和推广。为了解微创外科在患者住院费用中的增加情况，本研究对陕西省某三甲医院肝胆外科2017～2018年的同期开展的胰十二指肠切除分别采用微创手术与传统手术的疗效和住院费用进行回顾性分析，为顺利开展微创外科与精准手术的同时，使得医疗机构制定应对措施，并为医保报销政策提供依据。