Hidlebaugh D A, Orr R K
Department of Obstetrics and Gynecology, Fallon Clinic and Saint Vincent Hospital, Worcester, Massachusetts, USA.
J Am Assoc Gynecol Laparosc. 1998 Nov;5(4):351-6. doi: 10.1016/s1074-3804(98)80046-7.
To assess long-term costs of resectoscopic endometrial ablation versus hysterectomy in women with menorrhagia.
Controlled cohort study (Canadian Task Force classification II-2).
Multispeciality group practice.
Sixty-four women who underwent endometrial ablation during 1992-1994 and 46 women who underwent hysterectomy during 1990-1992. To attain comparable controls, patients with uterine size exceeding 14 weeks or uterine weight greater than 300 g, ovarian pathology, endometriosis, or neoplasia were excluded.
Endometrial ablation and hysterectomy, followed by economic evaluation.
Direct costs were hospitalization charges, professional fees, preoperative depot leuprolide, and gynecologic care during 3 years after primary surgery. Indirect costs were calculated based on known demographic data, recovery time, and lost productivity. Surgical outcomes, complications, repeat surgeries, menstrual outcomes, and overall patient satisfaction were assessed. Operating time (38 vs 107 min), hospital stay (0.7 vs 2.7 days), frequency of postoperative complications (6.3% vs 21.7%), and recuperation time (5 vs 32 days) were less with endometrial ablation than with hysterectomy. Mean follow-up was 48.5 months (range 36-68 mo), with rates of amenorrhea, hypomenorrhea, and eumenorrhea of 49%, 29%, and 8%, respectively. One patient was lost to follow-up. There were eight failures (12%): repeat endometrial ablations (2 women), abdominal hysterectomy (1), and laparoscopic-assisted hysterectomy (5). Most women (85%) remained satisfied with the operation. Total direct costs/case for endometrial ablation were $5434 versus $8417 for hysterectomy; respective indirect costs/case were $525 and $3360. Conclusion. Long-term direct and indirect costs of endometrial ablation were significantly less than those of hysterectomy ($5959 vs $11,777) for the treatment of menorrhagia.
评估宫腔镜子宫内膜切除术与子宫切除术治疗月经过多的长期成本。
对照队列研究（加拿大工作组分类II-2）。
多专科联合诊所。
1992年至1994年间接受子宫内膜切除术的64名女性和1990年至1992年间接受子宫切除术的46名女性。为获得可比的对照组，排除子宫大小超过14周或子宫重量超过300克、卵巢病变、子宫内膜异位症或肿瘤的患者。
子宫内膜切除术和子宫切除术，随后进行经济评估。
直接成本包括住院费用、专业费用、术前长效亮丙瑞林以及初次手术后3年内的妇科护理费用。间接成本根据已知的人口统计学数据、恢复时间和生产力损失进行计算。评估手术结果、并发症、再次手术、月经情况以及患者总体满意度。与子宫切除术相比，子宫内膜切除术的手术时间（38分钟对107分钟）、住院时间（0.7天对2.7天）、术后并发症发生率（6.3%对21.7%）和康复时间（5天对32天）均较短。平均随访48.5个月（范围36 - 68个月），闭经、月经过少和月经正常的发生率分别为49%、29%和8%。1例患者失访。有8例失败（12%）：再次子宫内膜切除术（2名女性）、腹式子宫切除术（1例）和腹腔镜辅助子宫切除术（5例）。大多数女性（85%）对手术仍感到满意。子宫内膜切除术的总直接成本/病例为5434美元，子宫切除术为8417美元；各自的间接成本/病例分别为525美元和3360美元。结论：对于月经过多的治疗，子宫内膜切除术的长期直接和间接成本显著低于子宫切除术（5959美元对11777美元）。
