Spirtos N M, Schlaerth J B, Gross G M, Spirtos T W, Schlaerth A C, Ballon S C
Women's Cancer Center of Northern California, Palo Alto, 94304, USA.
Am J Obstet Gynecol. 1996 Jun;174(6):1795-9; discussion 1799-800. doi: 10.1016/s0002-9378(96)70212-0.
The purpose of this study was to determine whether the cost or quality of life associated with surgical treatment of presumed early-stage endometrial cancer differed on the basis of the surgical approach.
A retrospective analysis was performed on a consecutive series of women with presumed early-stage endometrial cancer treated at the Women's Cancer Center of Northern California. The senior author was the surgeon, cosurgeon, or assistant on all cases. The women comprise two groups with different surgical approaches. The first group of 17 women underwent exploratory laparotomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic and aortic lymphadenectomy. The second group of 13 women underwent the same surgery by laparoscopy. The two groups were compared with a two-tailed Student t test. Variables analyzed included age, height, weight, Quetelet index, and predisposing medical problems. Lymph node counts were compiled. Hospital costs were broken down into four cost categories: (1) operating room, (2) hospital bed, (3) pharmacy, and (4) anesthesia. A two-tailed Student t test was also used in this analysis. Issues examined regarding quality of life included (1) average hospital stay, (2) complications, and (3) time to return to normal activity.
The patient population differed significantly (p < 0.05) with regard to weight and Quetelet index. The laparotomy group required significantly longer hospitalization than the laparoscopy group (6.3 vs 2.4 days, p < 0.001), resulting in higher overall hospital costs ($19,158 vs $13,988, p < 0.05). Similarly, patients undergoing laparotomy took longer to return to normal activity (5.3 weeks vs 2.4 weeks, p < 0.0001).
Laparoscopic management of endometrial cancer may result in significant cost savings and improved quality of life as demonstrated by shortened hospital stays and an earlier return to normal activity.
本研究旨在确定假定为早期子宫内膜癌的手术治疗所涉及的成本或生活质量是否因手术方式而异。
对在北加利福尼亚州妇女癌症中心接受治疗的一系列连续的假定为早期子宫内膜癌的女性患者进行回顾性分析。资深作者参与了所有病例的手术，担任主刀医生、助手医生或助理。这些女性患者分为两组，采用不同的手术方式。第一组17名女性接受了剖腹探查术、全腹子宫切除术、双侧输卵管卵巢切除术以及盆腔和主动脉淋巴结清扫术。第二组13名女性通过腹腔镜进行了相同的手术。两组采用双尾学生t检验进行比较。分析的变量包括年龄、身高、体重、体重指数以及基础医疗问题。统计了淋巴结数量。医院成本分为四类：（1）手术室，（2）住院床位，（3）药房，（4）麻醉。本分析也采用双尾学生t检验。关于生活质量所考察的问题包括：（1）平均住院时间，（2）并发症，（3）恢复正常活动的时间。
两组患者在体重和体重指数方面存在显著差异（p < 0.05）。剖腹手术组的住院时间明显长于腹腔镜手术组（6.3天对2.4天，p < 0.001），导致总体医院成本更高（19,158美元对13,988美元，p < 0.05）。同样，接受剖腹手术的患者恢复正常活动所需时间更长（5.3周对2.4周，p < 0.0001）。
子宫内膜癌的腹腔镜治疗可能显著节省成本并改善生活质量，表现为住院时间缩短和更早恢复正常活动。
