Anagnostopoulos A, Mitra S, Decruze B, Macdonald R, Kirwan J
Liverpool Women's Hospital NHS Trust, Crown Street, Liverpool L87SS, UK.
Leeds Institute for Biomedical and Clinical Sciences, University of Leeds, Leeds, West Yorkshire LS1 3EX, UK.
Obstet Gynecol Int. 2017;2017:2103763. doi: 10.1155/2017/2103763. Epub 2017 Jan 10.
. To compare the safety, efficacy, and direct cost during the introduction of laparoscopic radical hysterectomy within an enhanced recovery pathway. . A 1 : 1 single centre retrospective case control study of 36 propensity matched pairs of patients receiving open or laparoscopic surgery for early cervical cancer. . There were no significant differences in the baseline characteristics of the two cohorts. Open surgery cohort had significantly higher intraoperative blood loss (189 versus 934 mL) and longer postoperative hospital stay (2.3 versus 4.1 days). Although no significant difference in the intraoperative or postoperative complications was found more urinary tract injuries were recorded in the laparoscopic cohort. Laparoscopic surgery had significantly longer duration (206 versus 159 minutes), lower lymph node harvest (12.6 versus 16.9), and slower bladder function recovery. The median direct hospital cost was £4850 for laparoscopic radical hysterectomy and £4400 for open surgery. . Laparoscopic radical hysterectomy can be safely introduced in an enhanced recovery environment without significant increase in perioperative morbidity. The 10% higher direct hospital cost is not statistically significant and is expected to even out when indirect costs are included.
在强化康复路径下引入腹腔镜根治性子宫切除术期间，比较其安全性、有效性和直接成本。对36对倾向匹配的早期宫颈癌患者进行1:1单中心回顾性病例对照研究，这些患者分别接受了开放手术或腹腔镜手术。两组队列的基线特征无显著差异。开放手术组术中失血量显著更高（189对934毫升），术后住院时间更长（2.3对4.1天）。虽然术中或术后并发症无显著差异，但腹腔镜组记录到更多的泌尿系统损伤。腹腔镜手术持续时间显著更长（206对159分钟），淋巴结清扫数量更低（12.6对16.9），膀胱功能恢复更慢。腹腔镜根治性子宫切除术的直接医院成本中位数为4850英镑，开放手术为4400英镑。在强化康复环境中可安全引入腹腔镜根治性子宫切除术，围手术期发病率无显著增加。直接医院成本高出10%无统计学意义，纳入间接成本后预计会持平。
