探討胰臟部分切除手術之臨床成效與醫療資源耗用:開腹手術或微創手術之比較

Medical resource utilization and surgical outcomes for partial pancreatectomy:A comparative study between open and minimally invasive surgery

許莉宛(Li-Wan Hsu)

指導教授 ： 李金德

高雄醫學大學/健康科學院/醫務管理暨醫療資訊學系碩士在職專班/碩士(2019年)

摘要

研究目的
胰臟位在後腹腔，周圍血管分布複雜，此外擁有強力外分泌酵素功能的特異性，使得胰臟腫瘤手術較其他腹腔疾病的手術複雜，且併發症的風險也較高。現今由於微創手術器械及材料快速發展，相較於傳統開腹式手術傷口縮小、出血量顯著減少、病人疼痛感降低、更能快速復原回到工作崗位等，有諸多優點，因此目前對於胰臟遠端切除術，微創方式的手術也逐步成為治療的標準選擇，有研究發現採用微創式手術可以獲得更多優異的結果，故藉由創新科技導入，比較採用開腹手術和微創手術對醫療成效、醫療資源的影響是值得探討。本研究為探討台灣南部某醫學中心胰臟遠端部分切除手術使用開腹手術和微創手術，對當次住院的醫療資源利用及臨床醫療成效，並了解其相關影響因素。
研究方法
本研究採取回溯性研究設計(retrospective cohort design)，資料來源取自南台灣某醫學中心住院與門診雲端醫療資療庫和批價資料檔，利用資料回溯及病歷查閱進行收集，以描述性統計、推論性統計分析，卡方檢定、獨立性樣本T 檢定、複迴歸分析和對數迴歸分析檢視開腹式或微創式胰臟部分切除手術之臨床醫療成效與醫療資源利用之相關性。
研究結果
符合本研究條件個案共70位，採微創行胰臟遠端部分切除手術有36位，行開腹式胰臟部分切除手術有34位，研究結果發現微創式住院天數少於開腹式手術，微創式手術出血量較少、手術後禁食天數較短、術後發生胰瘺機率較低、術後疼痛分數較快達到小於3分，以及不同術式對臨床成效和醫療資源耗用有其顯著影響。
結論與建議
微創式胰臟遠端部分切除手術是未來發展趨勢，在此研究中亦可發現對其臨床成效較開腹式良好，因此在治療的可行性、安全性及有效性，提供醫界除了傳統開腹式手術切除的另一種常規治療方法，不僅能減少醫療成本耗用，且能讓病人獲得良好的手術醫療成效，亦能推廣醫院名聲。

關鍵字

開腹式胰臟部分切除 ； 微創式胰臟部分切除 ； 醫療資源耗用

並列摘要

Background
The pancreas is located in the retroperotoneum, and the surrounding blood vessels are complexly distributed. Nowadays, due to the rapid development of minimally invasive surgical instruments and materials, compared with the traditional open surgery wounds, the amount of bleeding is significantly reduced, the patient's pain is reduced, and the ability to quickly return to work, etc., has many advantages. therefore, minimally invasive surgery has gradually become the standard of choice for the current pancreas. It is worth exploring that comparing the use of open surgery and minimally invasive surgery on medical outcomes and the impact of medical resources through the introduction of innovatiue technology. This study discussed open surgery and minimally invasive surgery for partial pancreatectomy in a medical center in southern Taiwan.
Methods
The study used a retrospective cohort design. The data was obtained from a medical clinic and NHI pharma cloud and a medical data library in the medical center of South Taiwan. The data was collected by data review and medical records to descriptive statistics, inferential statistical analysis, chi-square test, independent sample T-test, complex regression analysis, and logistic regression analysis to examine the correlation between clinical outcomes and medical resource utilization in open or minimally invasive pancreatic partial resection.
Results
A total of 70 cases were eligible for this study. There were 36 cases of minimally invasive pancreatic distal partial resection, and 34 cases of open abdominal pancreatectomy. The results showed that the number of minimally invasive hospital stays was less than open surgery. Minimally invasive surgery with less bleeding, shorter days after surgery, lower incidence of postoperative pancreatic fistula, less postoperative pain scores less than 3 points. These two different surgical procedures have significant impact on clinical outcomes and medical resource consumption.
Conclusion
Minimally invasive distal partial resection of the pancreas can be found that its clinical effect is better than that of open surgery.

並列關鍵字

open pancreatectomy ； minimally invasive pancreatic partial resection ； medical resource consumption ； Clinical medical outcome

參考文獻

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