腹腔镜辅助下阴式子宫切除术治疗子宫内膜癌：临床疗效与住院费用

Laparoscopic-assisted vaginal hysterectomy for endometrial cancer: clinical outcomes and hospital charges.

作者信息

Gemignani M L, Curtin J P, Zelmanovich J, Patel D A, Venkatraman E, Barakat R R

机构信息

Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, 10021, USA.

出版信息

Gynecol Oncol. 1999 Apr;73(1):5-11. doi: 10.1006/gyno.1998.5311.

DOI:10.1006/gyno.1998.5311

PMID:10094872

Abstract

OBJECTIVE

Our objective was to compare the clinical outcomes and associated hospital charges between two methods of hysterectomy for patients with early-stage endometrial cancer.

METHODS

Retrospective chart review of 320 patients with early-stage endometrial cancer treated by laparoscopic-assisted vaginal hysterectomy (LAVH) or total abdominal hysterectomy (TAH) was performed for the period of July 1, 1991, to September 30, 1996, at Memorial Sloan-Kettering Cancer Center.

RESULTS

Sixty-nine patients (22%) were treated by LAVH, and 251 (78%) were treated by TAH. The majority of the patients (80%) had Stage I disease. The mean age was similar for both groups: 60 years for the LAVH vs 61 years for TAH. The mean weight was significantly lower for the LAVH group, 71 kg (range 43-117 kg), than for the TAH group, 82 kg (range 38-200 kg), (P < 0.05). Overall complication rates were lower among patients treated by LAVH. Operating room time was longer for the LAVH group (214 min) than for the TAH group (144 min) (P < 0.05). The median length of stay was significantly shorter for patients treated by LAVH (2.0 days) compared to TAH (6.0 days) (P < 0.05). Room charges were significantly higher for the TAH patients ($6960) compared to the LAVH patients ($3130) (P < 0.05). Overall mean total charges were significantly less for the LAVH group ($11,826) than for the TAH group ($15,189) (P < 0.05). With a median follow-up of 30 months for the TAH group and 18 months for the LAVH group, there was no significant difference in disease recurrence (P = 0.91).

CONCLUSION

Patients treated by LAVH for early-stage endometrial cancer had significantly shorter hospitalization and fewer complications, resulting in less overall hospital charges when compared to patients treated by TAH. Long-term outcome was similar. Laparoscopic-assisted vaginal hysterectomy is an attractive alternative for selected patients with early-stage endometrial cancer.

摘要

目的

我们的目的是比较早期子宫内膜癌患者两种子宫切除术方法的临床结局及相关住院费用。

方法

对1991年7月1日至1996年9月30日期间在纪念斯隆凯特琳癌症中心接受腹腔镜辅助阴道子宫切除术（LAVH）或经腹全子宫切除术（TAH）治疗的320例早期子宫内膜癌患者进行回顾性病历审查。

结果

69例（22%）患者接受了LAVH治疗，251例（78%）接受了TAH治疗。大多数患者（80%）为I期疾病。两组患者的平均年龄相似：LAVH组为60岁，TAH组为61岁。LAVH组的平均体重显著低于TAH组，分别为71 kg（范围43 - 117 kg）和82 kg（范围38 - 200 kg），（P < 0.05）。LAVH治疗的患者总体并发症发生率较低。LAVH组的手术室时间（214分钟）比TAH组（144分钟）长（P < 0.05）。LAVH治疗的患者中位住院时间（2.0天）明显短于TAH治疗的患者（6.0天）（P < 0.05）。TAH患者的病房费用（6960美元）明显高于LAVH患者（3130美元）（P < 0.05）。LAVH组的总体平均总费用（11,826美元）明显低于TAH组（15,189美元）（P < 0.05）。TAH组的中位随访时间为30个月，LAVH组为18个月，疾病复发率无显著差异（P = 0.91）。