Nakajima J, Takamoto S, Kohno T, Ohtsuka T
Department of Cardiothoracic Surgery, Faculty of Medicine, University of Tokyo, Japan.
Cancer. 2000 Dec 1;89(11 Suppl):2497-501. doi: 10.1002/1097-0142(20001201)89:11+<2497::aid-cncr31>3.3.co;2-x.
The costs of videothoracoscopic procedures for patients with lung carcinoma were compared with those of patients who underwent open thoracotomy in Japan.
The cost of surgical treatment in 1997 and 1998 for patients with resectable primary or metastatic lung carcinoma was analyzed from itemized statements of hospital charges. For patients with lung carcinoma who are in relatively poor health, the authors chose videothoracoscopic lobectomy or partial resection of the lung instead of an open thoracotomy. For patients with solitary pulmonary metastasis, the authors routinely performed thoracoscopic partial resection of the lung.
Among 102 patients who were selected for the analysis, 79 patients had primary lung carcinoma, and 23 had metastatic lung carcinoma. Sixty-six open thoracotomies and 36 thoracoscopic surgeries were performed. The mean hospital charge for the entire group of patients was $11,348 (U.S.). The total charges accrued in the operating room amounted to 63% of the hospital charges. Hospitalization was significantly shorter in the group of patients who underwent videothoracoscopy (17.3 days) compared with the group of patients who underwent open thoracotomy (23.8 days). The charges for laboratory examinations, anesthesia, disposable equipment, and hospitalization were significantly higher in patients who underwent open thoracotomy compared with the patients who underwent videothoracoscopy. There were no statistically significant differences in the charges for medication or surgical fees between the two groups.
The hospital charges for patients undergoing videothoracoscopic surgery were lower than the charges for patients undergoing open thoracotomy at the authors' hospital. The lower cost was attributable mainly to the less invasive nature of thoracoscopic surgical procedures, which also may be beneficial for decreasing the risk of postsurgical complications in patients in who are in relatively poor health.
在日本，对肺癌患者进行电视胸腔镜手术的费用与接受开胸手术的患者的费用进行了比较。
根据医院收费明细报表，分析了1997年和1998年可切除的原发性或转移性肺癌患者的手术治疗费用。对于健康状况相对较差的肺癌患者，作者选择电视胸腔镜肺叶切除术或肺部分切除术而非开胸手术。对于孤立性肺转移患者，作者常规进行胸腔镜肺部分切除术。
在入选分析的102例患者中，79例为原发性肺癌，23例为转移性肺癌。进行了66例开胸手术和36例胸腔镜手术。整个患者组的平均住院费用为11,348美元（美国）。手术室产生的总费用占住院费用的63%。接受电视胸腔镜检查的患者组的住院时间（17.3天）明显短于接受开胸手术的患者组（23.8天）。与接受电视胸腔镜检查的患者相比，接受开胸手术的患者在实验室检查、麻醉、一次性设备和住院方面的费用明显更高。两组在药物费用或手术费用方面没有统计学上的显著差异。
在作者所在医院，接受电视胸腔镜手术的患者的住院费用低于接受开胸手术的患者。成本较低主要归因于胸腔镜手术的侵入性较小，这也可能有利于降低健康状况相对较差的患者术后并发症的风险。
