不同的人工網膜運用於腹股溝疝氣修補手術之醫療成效及醫療資源耗用分析

背景腹股溝疝氣，是一個很常見的疾病，男、女、老人、小孩都有可能發生，發生率約為5-10％。疝氣的發生會讓病患感到疼痛、影響外表的美觀，如果放任不去理會，受損部位會隨著時間增長越變越大，也可能造成嵌頓性疝氣及腸壞死，嚴重的話甚至會引起死亡。疝氣修補手術是常見的外科手術之一，自1958年開始以人工網膜進行疝氣缺口修補，至今已經被廣泛使用。選擇適當的人工網膜在疝氣修補手術上是一項很重要的事情。良好的醫療成效可以避免併發症的發生及縮短住院天數進行費用控制。本研究的目的在進行不同的人工網膜運用在腹股溝疝氣修補手術的比較，將結果作為醫療政策上醫療資源規劃與運用的參考。研究方法依據目前疝氣修補手術常用的人工網膜，分成輕質量Light-Weight（ L – W ）及重質量Heavy-Weight（ H – W ）兩大類。本研究收集南部某區域教學醫院2008年1月至2008年12月期間進行腹股溝疝氣修補手術、使用Light-Weight人工網膜（175例）及Heavy-Weight人工網膜（163例）二組病患共338例的資料，分析手術時間、住院天數、住院醫療費用、疼痛、併發症及復發情形，以瞭解這二組病患在醫療成效及醫療資源耗用上的差異性。研究資料以SPSS for Windows 14.0統計套裝軟體作為分析工具。研究結果統計結果顯示腹股溝疝氣修補手術中使用輕質量（ L- W ）人工網膜組與使用重質量（ H – W ）人工網膜組在住院天數、併發症及復發情形上沒有顯著差異（P＞0.05）；在手術時間及疼痛上具有顯著差異性（P＜0.05）。使用重質量（ H – W ）人工網膜的病患比使用輕質量（ L – W ）人工網膜的病患在手術時間上多7.706分鐘（P＜0.05）。使用 H – W 人工網膜比使用 L – W 人工網膜在手術後第一天疼痛指數上多0.451分（P＜0.05）。使用 H – W 人工網膜的病患比使用 L – W 人工網膜的病患在手術後三個月的疼痛指數多0.272分（P＜0.05）；使用 H – W 人工網膜的病患比使用 L – W 人工網膜的病患在手術後十二個月的疼痛指數多0.153分（P＜0.05）。醫療費用上，因為 L – W 人工網膜需自費，所以比 H – W 人工網膜組多支付約8500元的醫療費用。結論台灣一年約有40,000例疝氣修補手術，使用人工網膜疝氣修補手術在疼痛感、住院天數及復發率上都優於傳統疝氣組織縫合手術，近年來使用人工網膜修補疝氣缺口已經是一種使用率高而且方便的技術，甚至有一些國家已經將人工網膜修補疝氣缺口視為疝氣修補手術的標準方式。由於科技的進步，在Light-Weight（ L – W ）mesh的構造及材質上發展出多樣化人工網膜，不僅可以讓病患在發炎反應及異物感上得到改善，也讓醫師在使用上更方便，可以在手術時間上節省時間降低醫療成本。本研究的結果可以提供醫療政策在制訂時的依據及醫師在提供病患選擇醫療方式時的參考。

關鍵字

疝氣；疝氣修補手術；人工網膜；醫療成效

並列摘要

Background Inguinal hernia is a very common disease. The incidence is around 5-10% in the general population. Hernia will cause pain and affect the appearance. Also the incarcerated hernia may lead to intestinal necrosis and even death.In 1958, the polypropylene mesh was first used in hernia repair. Mesh repair is now standard in most countries and widely accepted as superior to tissue repair. As a result, there has been a rapid growth in the variety of meshes available and choosing the appropriate one can be difficult. The aim of this study is to compare different mesh in the repair of inguinal hernia with the efficiency analysis. Materials and methods This study was conducted over a period of one year from January 2008 to December 2008. A total of 338 cases suffering from inguinal hernia were divided into two group ：（1）Light-Weight mesh group,175 cases （2）Heavy-weight mesh group,163 cases. We follow up the operation time, hospital stay, the cost of hospitalization, chronic pain, complications and recurrence rate. Results There has no significant difference in hospital stay, complications and recurrence rate. There has significant difference in operation time, chronic pain and cost of hospitalization. Heavy-weight mesh group need more operation time than light-weight mesh group（Heavy-weight mesh group ：48.85 minutes, light-weight mesh group ：38.67 minutes）. In First post operative day, heavy-weight mesh group get more pain score than light-weight mesh group（Heavy-weight mesh group pain score ：4.27 points, light-weight mesh group pain score ：3.67 point）. In 3 months post operation, heavy-weight mesh group get more pain score than light-weight mesh group（Heavy-weight mesh group pain score ：0.47 points, light-weight mesh group pain score ：0.19 point）. In 12 months post operation, heavy-weight mesh group get more pain score than light-weight mesh group（Heavy-weight mesh group pain score ：0.22 points, light-weight mesh group pain score ：0.07 point）. Light-Weight mesh group spend more money in cost of hospitalization than heavy-weight mesh group（Heavy-weight mesh group cost ：NT 28570.51 dollars, light-weight mesh group cost ：NT 37317.29 dollars ）. Conclusions In Taiwan, there are about 40,000 hernia repairs every year. The use of mesh repair has lower recurrence rate and lower complication rate than tissue repair. From our study, the light-weight mesh need less operation time than Heavy-weight mesh. The light-weight mesh group also has better result of chronic pain than heavy-weight mesh group. The results of this study can provide the reference to the bureau of health care policy and also to provide