探討兩孔式與三孔式腹腔鏡膽囊切除手術之醫療品質與資源耗用分析

Investigation and Analysis of Medical Quality and Resource Consumption for Double-and Triple-incision Laparoscopic Cholecystectomy Surgery

吳美珠(Mei-Chu Wu) ； 王乙茜(Yi-Chian Wang) ； 陳亞玲(Ia-Ling Chen) ； 莊世昌(Shih-Chang Chuang) ； 侯雅萍(Ya-Pin Hou)

《澄清醫護管理雜誌》 14卷1期 (2018/01) Pp. 32-38

摘要

目的：膽囊結石病人在台灣的盛行率有持續上升的趨勢，無症狀的膽囊結石只需定期追蹤，溶解結石是無法治療膽囊結石，手術切除是最根本有效的治療方式；其腹腔鏡膽囊切除手術為目前的主流，故本研究目的在比較「兩孔式」與「三孔式」腹腔鏡膽囊切除術兩種手術方式之醫療品質與資源耗用成效，以作為病人及手術者決策時之參考。方法：本研究採病歷回溯描述性研究，於2013年5月至2013年11月針對外科病人60位個案進行醫療品質及醫療資源耗用額度差異之分析。結果：分析結果顯示在術後併發症及醫療整體滿意度無顯著差異；在醫療費用中兩孔式腹腔鏡膽囊切除手術低於三孔式，達統計上的顯著意義。結論：根據本研究兩孔式腹腔鏡膽囊切除手術其術後併發症、平均住院日及傷口疼痛皆無差異，此手術確實有正面價值不僅節省醫療成本支出更可美觀手術傷口，並提升病人滿意度；其結果可供醫院對腹腔鏡膽囊切除術住院病人Tw-DRGs制度下經營管理及提供病人手術選擇的參考。

關鍵字

兩孔式 ； 三孔式 ； 腹腔鏡膽囊切除手術

並列摘要

Purposes: The number of patients with gallstones has continued to increase in Taiwan, and regular follow-ups can effectively monitor the conditions of asymptomatic gallstones. However, dissolution cannot completely cure gallstones, and surgical resection is the most effective treatment for gallstones. Among various surgical techniques, laparoscopic cholecystectomy surgery (LCS) is currently the mainstay treatment. Thus, the purpose of this study was to compare the effectiveness of double- and triple-incision LCS in terms of medical quality and resource consumption, as a reference for patients and surgeons. Methods: This is a retrospective descriptive study. Sixty patients who underwent surgery between May 2013 and November 2013 were included in this study for analysis of differences in medical quality and resource consumption. Results: The analysis results suggested no significant differences in postoperative complications and overall medical satisfaction. However, the medical resource cost of double-incision LCS was significantly lower than that of triple-incision LCS. Conclusions: According to this study, no significant differences in the occurrence of postoperative complications, mean hospitalization duration, and surgical wound pain were found between double- and triple-incision LCS. Therefore, it confirmed that double-incision LCS not only positively reduced medical expenses but also resulted in more aesthetically pleasing surgical wounds, thus increasing patient satisfaction. These results can be used as important references for the management of inpatients under the Tw-DRGs system and providing surgical options.

並列關鍵字

Double-incision ； Triple-incision ； Laparoscopic cholecystectomy surgery (LCS)