探討兩孔式與三孔式腹腔鏡膽囊切除手術之醫療品質與資源耗用分析

Investigation and Analysis of Medical Quality and Resource Consumption for Double-and Tripleincision Laparoscopic Cholecystectomy Surgery

膽囊結石病人在台灣的盛行率有持續上升的趨勢，無症狀的膽囊結石只需定期追蹤，溶解結石是無法治療膽囊結石，手術切除是最根本有效的治療方式；其腹腔鏡膽囊切除手術為目前的主流，故本研究目的在比較「兩孔式」與「三孔式」腹腔鏡膽囊切除術兩種手術方式之醫療品質與資源耗用成效，以作為病人及手術者決策時之參考。方法本研究採病歷回溯描述性研究，於2013年5月至2013年11月針對外科病人60位個案進行醫療品質及醫療資源耗用額度差異之分析。

PurposesThe number of patients with gallstones has continued to increase in Taiwan, andregular follow-ups can effectively monitor the conditions of asymptomatic gallstones.However, dissolution cannot completely cure gallstones, and surgical resection is themost effective treatment for gallstones. Among various surgical techniques, laparoscopiccholecystectomy surgery (LCS) is currently the mainstay treatment. Thus, the purpose ofthis study was to compare the effectiveness of double- and triple-incision LCS in terms ofmedical quality and resource consumption, as a reference for patients and surgeons.MethodsThis is a retrospective descriptive study. Sixty patients who underwent surgerybetween May 2013 and November 2013 were included in this study for analysis ofdifferences in medical quality and resource consumption.ResultsThe analysis results suggested no significant differences in postoperativecomplications and overall medical satisfaction. However, the medical resource cost ofdouble-incision LCS was significantly lower than that of triple-incision LCS.ConclusionsAccording to this study, no significant differences in the occurrence of postoperativecomplications, mean hospitalization duration, and surgical wound pain were found betweendouble- and triple-incision LCS. Therefore, it confirmed that double-incision LCS notonly positively reduced medical expenses but also resulted in more aesthetically pleasingsurgical wounds, thus increasing patient satisfaction. These results can be used as importantreferences for the management of inpatients under the Tw-DRGs system and providingsurgical options.