不同脾蒂离断法在腹腔镜脾切除治疗ITP中的成本-效果比较

摘要

目的 比较腹腔镜下原位二级脾蒂离断法脾切除术(laparoseopic splenectomy by secondary pedicle division,LSSP)和腹腔镜下直线切割闭合器脾切除术(laparoscopic splenectomy by Endo-GIA.LSED)治疗特发性血小板减少性紫癜(idiopathic thrombocytopenic purpura.ITP)的成本-效果.方法 收集本院2007年5月～2009年6月因ITP行腹腔镜下脾切除术治疗的患者42例,随机分为LSSP和LSED两组,每组21例,比较两种治疗方法的疗效差异,并进行成本-效果分析.结果 LSSP组的手术时间、术中出血量、术中住院时间分别为(152.8±61.4)min、(202.5±88.4)mL和(5.9±0.7)d,与LSED组(161.5±31.8)min、(219.7±79.6)mL和(6.1±0.4)d相比均无统计学差异(P＞0.05).LSSP组治疗总有效率为81.0%,与LSED组(90.5%)相比无统计学差异(P＞0.05).而在手术费用上LSSP组为(7681.7±752.1)元,与LSED组的(10138.5±631.3)元相比差异有显著性(P＜0.05).结论 LSSP治疗ITP的治疗效果与LSED相近,但更节约医疗成本.%Objective To compare a highly cost-effective laparoscopic splenectomy for the treatment of ITP with two different pedicle division strategy. Methods From May 2007 to June 2009, 42 consecutive patients of ITP were undergone laparoscopic splenectomy. The splenic pedicle was controlled by secondary pedicle division strategy in 21 cases (the group of LSSP) and by Endo-GIA in the other 21 cases (the group of LSED). A retrospective study was carried out to evaluate the operative duration, volume of blood loss, duration of hospitalization and so on between two groups. Results LS was performed successfully in a total of 42 cases. There was no significant difference between the two groups in operative duration, duration of hospitalization, volume of blood loss and so on. The group of LSSP(RMB 7681.7±752.1) was significantly lower than that of the group of LSED (RMB 10138.6±631.3)(P＜0.05). Conclusion Laparoscopic splenectomy by secondary pedicle division strategy is a safe, effective and economical procedure with the value of popularization in developing area.