“開腹手術”與“腹腔鏡手術”切除子宮肌瘤之成效比較－以某醫學中心爲例

子宮肌瘤是婦女骨盆腔中最常見的腫瘤，也是婦產科手術人數第二多的手術。故本研究目的在比較「開腹手術」與「腹腔鏡手術」兩種方法的手術成效，以作爲病患及醫院管理者在做決策時之參考。本研究以個案醫院2006年1月至2007年12月之健保申報資料、病歷資料及成本會計資料，針對438位個案進行分析探討，所採用的統計方法，包括t檢定及複迴歸分析，比較兩種手術的手術時間、麻醉時間、住院天數、手術出血量、住院醫療成本及醫院收入的差異。分析結果顯示，控制個案之體脂質、手術方式及肌瘤數量後，在臨床效果方面，腹腔鏡手術平均花費時間及平均麻醉時間均高於開腹手術；腹腔鏡手術的平均住院天數、手術的平均出血量均少於開腹手術；在醫療成本部分，腹腔鏡手術醫療成本平均低於開腹手術；醫療費用收入，腹腔鏡手術收入平均高於開腹手術，以上結果均達到統計上的顯著意義。

關鍵字

子宮肌瘤；開腹手術；腹腔鏡手術；成效分析

並列摘要

Uterine myoma is the most common type of tumor [in OR affecting OR involving] the pelvic cavity, and is the second most common tumor in patients undergoing gynecology surgery. This investigation thus compares outcomes between ”open myomectomy” and ”laparoscopic myomectomy” with regard to uterine myoma removal. With limited medical resources, understanding of the quality and costs of different survey options can provide a reference for patients and hospital administrators in making related decisions for ”open myomectomy” and ”laparoscopic myomectomy”. The data sources used in this study comprise health insurance report data files and charts for a medical center in Taipei city. The data comprises 438 cases of ”open myomectomy” presenting at the sample hospital from January 2006 to December 2007]. Operating time, anesthetic time, length of stay, and intra-operative blood loss between both types of myomectomy are analyzed and compared via t-test. Multiple regression analysis is then conducted to examine the predictive factors that influencethe costs and outcomes of both types of surgery. Conclusions: From the hospital perspective, The results indicate that laparoscopic myomectomy is less costly and more beneficial treatment strategy than open myomectomy.

並列關鍵字

Myoma ； open myomectomy ； laparoscopic myomectomy ； outcome analysis

參考文獻

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