「開腹手術」與「腹腔鏡手術」切除子宮肌瘤之成 效比較
—以某醫學中心為例
子宮肌瘤是在婦女的骨盆腔中最常見的腫瘤，也是佔婦產科手術人數第二多的手術。在醫療資源有
限的現況下，了解不同的手術方式之品質及費用是否有差異，其研究發現應可作為病患本身及醫院 管理者在做相關決策時之參考。
本研究係利用某醫學中心的健保申報資料檔及病歷資料，以比較「開腹手術」與「腹腔鏡手術」切 除子宮肌瘤之成效。本研究除了比較兩種方法的手術時間、麻醉時間、住院天數、及手術出血量外
，並從醫院的營運觀點，進一步比較手術成本及醫院收入的差異。
本研究以個案醫學中心於 2006 年 1 月 -2007 年 12 月之健保申報資料、病歷資料及成本會計資料，
針對 438 位個案進行分析探討，其中資料採取開腹手術者有 264 位，而採取腹腔鏡手術者則有 174 位，本研究所採取的統計方法則包括 t 檢定及複迴歸分析。
分析結果顯示，控制個案之體脂質、手術方式及肌瘤數量後，肌瘤大於 10cm 的手術時間、出血量
顯著高於肌瘤小於 ( 等於 )10cm 者。在臨床效果方面，腹腔鏡手術所平均花費時間為 112.6 分，而 開腹手術所平均花費時間則為 97.5 分；腹腔鏡手術的平均麻醉時間為 140.8 分，而開腹手術的平均 花費時間為 122.6 分；腹腔鏡手術的平均住院天數為 3.2 天，而開腹手術的平均住院天數則為 5.5 天
；腹腔鏡手術的平均出血量為 100.1cc ，而開腹手術的平均出血量則為 276.2cc 。在醫療費用收入 方面，腹腔鏡手術平均為 56,305 元，而開腹手術則平均為 41,307 元。在住院醫療成本方面，腹腔 鏡手術平均為 16,376 元，而開腹手術則平均為 19,165 元。
依據本研究之研究發現，提出下列建議： (1) 子宮肌瘤切除術是否適用以腹腔鏡完成，應視子宮肌 瘤的數量、大小及個案的體脂質而定，非單以傷口大小、出血量及住院天數決定。 (2) 醫院應該發 展醫療處置標準化，以避免醫療品質成為成本控制下的犧牲品。另一方面，也可藉由醫療處置的標 準化，來檢視醫療流程是否有浪費的情形發生。
Comparisons of the Outcomes between the Conventional a nd
Laparoscopic Myomectomy—Example of Some Medical
Uterine myoma is the most common type of tumor in the pelvic cavity, and is the second highest for those who undergo gynecology surgery. With limited medical resources, understanding of qualities and costs of different types of surgery can be used as a reference for patients and hospital administrators in making relat ed decisions.
Therefore, the purpose of this study is to compare the outcomes between “open myomectomy” and “laparo scopic myomectomy” regarding removing uterine myoma. Data sources are the health insurance report dat a files and charts of a medical center in Taipei city. There were 438 cases between January 2006 and Dece mber 2007 at the sample hospital. Operating time, anesthetic time, length of stay, and intra-operative blood loss between both types of myomectomy are analyzed and compared by using t-test. Multiple regression an alysis is then used to examine the predictive factors that impact the costs and outcomes of both types of sur gery.
The results indicate that, in terms of clinical results, laparoscopic myomectomy takes 112.6 minutes on average, and open myomectomy 97.5 minutes; laparoscopic myomectomy requires an average of 140.8 minutes for anesthesia, and open myomectomy 122.6 minutes; laparoscopic myomectomy requires an aver age of 3.2 days of hospital stay, and open myomectomy 5.5 days; and finally, laparoscopic myomectomy c auses an average of intra-operative blood loss of 100.1cc, and open myomectomy 276.2cc, laparoscopic m yomectomy costs an average of NT$56,305, and open myomectomyNT$41,307. In regard to hospitalizatio n costs, laparoscopic myomectomy costs an average of NT$16,376, and open myomectomy NT$19,165.
Based on findings of this study, the following suggestions are proposed: (1). If myomectomy should be do ne with laparoscopy is dependent upon the type, location, and size of uterine myoma, as well as whether th ere are complications. Physicians had better not judge on the size of the wound, the amount of blood loss, a nd the length of stay only. (2). Hospitals should develop standardized medical treatment procedures; theref ore, cost control would not be at the expense of the quality of care. Furthermore, standardization of medica l treatment can be used to pinpoint whether there is any waste in the medical treatment process.
