laparoscopic胆囊切除术前查结肠镜的临床和医学经济价值
Tsuyoshi Igami1, Masanao Nakamura2, Takuya Ishikawa2
1Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
概括
在腹腔镜胆囊切除术 (LC) 之前的查结肠镜 (SC) 是具有成本效益的,特别是对于55岁及以上的患者. 这种方法确定了需要切除的显著比例的结直肠瘤,证明了它的临床必要性.
科学领域:
- 胃肠病学 胃肠病学
- 手术瘤学手术瘤学
- 卫生经济学 卫生经济学
背景情况:
- 在腹腔镜胆囊切除术 (LC) 之前查结肠镜 (SC) 的临床实用性受到争论.
- SC通常被接受用于结直肠癌查.
研究的目的:
- 评估在LC之前进行的SC的临床价值和成本效益.
- 为了评估需要切除的结直肠瘤 (CRN) 的检测率,在接受SC之前进行LC的患者中进行切除.
主要方法:
- 对509名接受LC治疗的患者电子病历的回顾性审查.
- 对SC和CRN治疗的技术费用分析在335名手术前SC患者中.
- 在手术前SC.患者和没有SC.患者之间的成本比较.
主要成果:
- 术前SC患者中有13.1%的CRN需要切除 (晚期腺瘤或腺癌).
- 随着年龄的增长,CRN检测率增加,在年龄≥75.5的患者中达到22.9%.
- 手术前的SC显著更具成本效益 (每人250美元),而不是检测CRN后LC (每人8000美元).
结论:
- 在LC之前安排SC为结直肠癌查提供了宝贵的机会.
- 对于55岁及以上的患者,由于CRN检测率高,SC在LC之前是临床的必要性.
- 手术前的SC在治疗结直肠瘤方面表现出显著的成本效益.
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