南台灣膽石症以腹腔鏡膽囊切除術與開腹式膽囊切除術之醫療利用分析

Medical Utility Analysis Between Laparoscopic and Open Cholecystectomy For Gallstone Disease in Southern Taiwan

陸宏銘(Horn-Ming Lu)

指導教授 ： 郭功楷

高雄醫學大學/藥學院/藥學研究所/碩士(2006年)

摘要

研究背景：隨著飲食與生活型態愈趨西化的影響下，國人膽結石盛行率有日漸攀升的趨勢，因此膽結石疾病已經成為越來越普遍的疾病，為影響國人健康的重要問題。膽囊切除術是治療膽結石疾患的主要治療方法，適合各種型態的結石。
研究目的：本研究中希望能透過全民健康保險資料庫，就國人接受膽囊切除術的醫療情形作探討，以了解目前國內對於膽結石相關疾患的治療方式，探討膽囊切除手術治療模式的醫療利用情形。
研究方法：本研究採取回溯性研究(Retrospective study)，資料分析來源取自於健保資料庫，以南部地區2002年1月到2004年6月申報進行膽囊切除術案件共7712筆來進行研究。將病患依其手術型態分成三類，腹腔鏡膽囊切除術、腹腔鏡轉換開腹型膽囊切除術、開腹型膽囊切除術，再依其就醫記錄，進行檢查診斷、共病率、住院日數及耗費醫療成本等比較分析。
研究結果：急性膽囊炎的症狀明顯地的影響直接醫療成本，特別是對腹腔鏡膽囊切除術，在病人尚未產生急性發炎的臨床症狀前，直接醫療成本皆相對地較低，而在病人有急性發炎的臨床症狀時，易由腹腔鏡轉換為開腹型膽囊切除術，相對地，在患者為非急性發炎期，便執行腹腔鏡膽囊切除術，則可以降低病患的直接醫療成本以及住院日數，進而達到節省醫療資源的目的。
結論：有症狀膽囊結石，一旦合併急性膽囊炎時，因局部解剖會變得不明，腹腔鏡手術成功率會下降，併發症會增加，某些患者必須轉換成傳統開腹型膽囊切除手術，因而增加手術費用及住院日數。因此，目前歐美各國都建議此類病患即早接受腹腔鏡膽囊切除術。

關鍵字

腹腔鏡膽囊切除術 ； 腹腔鏡轉換開腹型膽囊切除術 ； 開腹型膽囊切除術 ； 急性膽囊炎

並列摘要

Background：With the effects of westernized foods and life style, our countrymen’s prevalence of gallstones had become higher. Thus gallstone disease had become more common and been a risk to affect the thealth of our countrymen. Cholecystectomy is the main way to treat gallstone disease, fitting all type of gallstones.
Objectives：This research study the medical situation of cholecystectomy through health insurance database, to understand the the treatment of gallstone disease and study the medical utility of cholecystectomy.
Methods：This research is belong to retrospective study. The data resource is from health insurance database, and the 7712 case conditions was applied for cholecystectomy during 2002 January to 2004 June in south Taiwan. Then we divided the patients into three parts according to the operations, as laparoscopic cholecystectomy, laparoscopic convert open cholecystectomy and open cholecystectomy. And we compared and analyzed the diagnosis, comorbidity index, length of stay, and medical costs according as the medical treatment records.
Results：Acute cholelithiasis notably affect the direct medical costs of the patients with laparoscopic cholecystectomy. For the patients with laparoscopic cholecystectomy, the direct medical costs are lower relatively before the symptom of acute cholelithiasis. Once the patients have acute cholelithiasis, their operation is easily converted into open cholecystectomy. Thus the patients having laparoscopic cholecystectomy in the phase of non-acute cholelithiasis can reduce the direct medical costs and hospital stay.
Conclusion：Symptomatic gallstone disease that combined with acute cholelithiasis may cause anatomic situation become unclear. Then reduce the strike-rate of laparoscopic cholecystectomy and cause more complications. Thus some patients have to convert into open cholecystectomy and increase the medical costs and hospital stay. So the physicians of European and U.S.A. suggest those patients accept laparoscopic cholecystectomy as soon as possible.

並列關鍵字

Lapaoscopic cholecystectomy ； Laparoscopic convert open cholecystectomy ； Open cholecystectomy ； Acute cholecystitis

參考文獻

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