Smith Shane R, Genden Eric M, Urken Mark L
Department of Otolaryngology, Mt Sinai Medical Center, One Gustave Levy Place, Box 1189, New York, NY 10029, USA.
Arch Otolaryngol Head Neck Surg. 2002 Feb;128(2):141-4. doi: 10.1001/archotol.128.2.141.
Presently, the 2 most widely used methods for the treatment of Zenker diverticulum are endoscopic stapling of the common party wall between the diverticulum sac and the esophagus and the standard open-neck technique involving diverticulectomy and cricopharyngeal myotomy.
To perform an analysis of the hospital charges to determine the economic efficiency of each technique based on our experience at the Mt Sinai Medical Center, New York, NY.
A retrospective analysis of 16 patients diagnosed as having Zenker diverticulum was conducted. Eight randomly chosen patients underwent endoscopic stapling with an EndoGIA 35-mm endoscopic stapler (Ethicon Inc, Somerville, NJ), and 8 randomly chosen patients underwent a standard open approach with diverticulectomy. Medical records were reviewed to determine operative time, length of hospital stay, time to oral intake, and postoperative complications. A charge analysis of the operative and postoperative fees was also performed. Statistical analysis between the 2 groups was conducted using analysis of variance and the paired t test.
The mean +/- SD operative time for the endoscopic stapling technique was 25.5 +/- 15.78 minutes, which was significantly less (P<.001) than that for the open procedure, 87.6 +/- 35.10 minutes. The mean operative charges were roughly equivalent at US$ 5178 for the endoscopic procedure and US$ 5113 for the open procedure. The endoscopic procedure, while shorter in operative time, had the added expense of specialized equipment, specifically the EndoGIA endoscopic stapler. The mean +/- SD length of hospital stay for the endoscopic procedure was significantly shorter (P<.001) at 1.3 +/- 0.59 days vs 5.2 +/- 1.03 days for the open procedure. The inpatient hospital charges for the endoscopic group was also significantly less (P<.001) at a mean of US$ 3589 per stay vs US$ 11,439 for the open group. The mean +/- SD time to oral intake was significantly shorter (<.001) at a mean of US$ 3589 per stay vs US$ 11,439 for the open group. The mean +/- SD time to oral intake was significantly shorter (P<.001) in the endoscopic group at 0.8 +/- 0.26 days vs 5.1 +/- 1.25 days for the open group. There were no major complications in either group, and all patients experienced resolution of preoperative symptoms.
Compared with the standard open technique, the endoscopic stapling technique for the treatment of Zenker diverticulum results in a statistically significant shorter operative time, hospital stay, and time to resume oral feedings. While the charges of the operative procedures were roughly equivalent, the total hospital charges were significantly less for the patients treated endoscopically.
目前，治疗Zenker憩室最广泛使用的两种方法是对憩室囊与食管之间的共同分隔壁进行内镜吻合钉合，以及采用包括憩室切除术和环咽肌切开术的标准开放性颈部手术。
根据我们在纽约州纽约市西奈山医学中心的经验，对住院费用进行分析，以确定每种技术的经济效益。
对16例诊断为Zenker憩室的患者进行回顾性分析。随机选择8例患者使用35毫米EndoGIA内镜吻合器（Ethicon公司，新泽西州萨默维尔）进行内镜吻合钉合，另外8例随机选择的患者采用标准开放性手术进行憩室切除术。查阅病历以确定手术时间、住院时间、开始经口进食时间和术后并发症。还对手术及术后费用进行了费用分析。两组之间的统计分析采用方差分析和配对t检验。
内镜吻合钉合技术的平均手术时间为25.5±15.78分钟，显著短于开放性手术的87.6±35.10分钟（P<0.001）。内镜手术的平均手术费用约为5178美元，开放性手术为5113美元，大致相当。内镜手术虽然手术时间较短，但增加了专用设备的费用，特别是EndoGIA内镜吻合器。内镜手术的平均住院时间显著较短（P<0.001），为1.3±0.59天，而开放性手术为5.2±1.03天。内镜组的住院费用也显著较低（P<0.001），平均每次住院3589美元，而开放组为11439美元。内镜组开始经口进食的平均时间显著较短（P<0.001），为0.8±0.26天，而开放组为5.1±1.25天。两组均无重大并发症，所有患者术前症状均得到缓解。
与标准开放性技术相比，治疗Zenker憩室的内镜吻合钉合技术在手术时间、住院时间和恢复经口进食时间方面在统计学上显著缩短。虽然手术费用大致相当，但内镜治疗患者的总住院费用显著较低。
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