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电视辅助胸腔镜手术肺叶切除术治疗肺癌的成本与效果

Cost and effectiveness of lung lobectomy by video-assisted thoracic surgery for lung cancer.

作者信息

Mafé Juan J, Planelles Beatriz, Asensio Santos, Cerezal Jorge, Inda María-Del-Mar, Lacueva Javier, Esteban Maria-Dolores, Hernández Luis, Martín Concepción, Baschwitz Benno, Peiró Ana M

机构信息

Department of Thoracic Surgery, Department of Health of Alicante-General Hospital, Alicante, Spain.

Neuropharmacology on Pain (NED), Research Unit, Department of Health of Alicante-General Hospital, ISABIAL, Spain.

出版信息

J Thorac Dis. 2017 Aug;9(8):2534-2543. doi: 10.21037/jtd.2017.07.51.

Abstract

BACKGROUND

Video-assisted thoracic surgery (VATS) emerged as a minimally invasive surgery for diseases in the field of thoracic surgery. We herein reviewed our experience on thoracoscopic lobectomy for early lung cancer and evaluated Health System use.

METHODS

A cost-effectiveness study was performed comparing VATS vs. open thoracic surgery (OPEN) for lung cancer patients. Demographic data, tumor localization, dynamic pulmonary function tests [forced vital capacity (FVC), forced expiratory volume in one second (FEV1), diffusion capacity (DLCO) and maximal oxygen uptake (VO2max)], surgical approach, postoperative details, and complications were recorded and analyzed.

RESULTS

One hundred seventeen patients underwent lung resection by VATS (n=42, 36%; age: 63±9 years old, 57% males) or OPEN (n=75, 64%; age: 61±11 years old, 73% males). Pulmonary function tests decreased just after surgery with a parallel increasing tendency during first 12 months. VATS group tended to recover FEV1 and FVC quicker with significantly less clinical and post-surgical complications (31% 53%, P=0.015). Costs including surgery and associated hospital stay, complications and costs in the 12 months after surgery were significantly lower for VATS (P<0.05).

CONCLUSIONS

The VATS approach surgery allowed earlier recovery at a lower cost than OPEN with a better cost-effectiveness profile.

摘要

背景

电视辅助胸腔镜手术(VATS)作为胸外科疾病的一种微创手术应运而生。我们在此回顾了我们在早期肺癌胸腔镜肺叶切除方面的经验,并评估了卫生系统的使用情况。

方法

对肺癌患者进行了一项成本效益研究,比较了VATS与开胸手术(OPEN)。记录并分析了人口统计学数据、肿瘤定位、动态肺功能测试[用力肺活量(FVC)、一秒用力呼气量(FEV1)、弥散功能(DLCO)和最大摄氧量(VO2max)]、手术方式、术后细节及并发症。

结果

117例患者接受了VATS(n = 42,36%;年龄:63±9岁,男性占57%)或OPEN(n = 75,64%;年龄:61±11岁,男性占73%)肺切除术。肺功能测试在术后即刻下降,在最初12个月内呈平行上升趋势。VATS组FEV1和FVC恢复得更快,临床和术后并发症明显更少(31%对53%,P = 0.015)。VATS的手术及相关住院费用、并发症及术后12个月的费用显著更低(P < 0.05)。

结论

与开胸手术相比,VATS手术方式能以更低的成本实现更早的恢复,具有更好的成本效益。

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