| BackgroundUterine leiomyoma is a common benign tumor of female genital organs. It is mainly caused by uterine smooth muscle cells proliferation, and is clinically characterized by increased menstrual flow, extended menstrual period, increased leukorrhea, abdominal pain, lower abdominal mass, and other symptoms. Most patients may not have obvious symptoms. Sometimes it can only be found during health examination. The incidence of uterine leiomyoma was about 20%-30%. As living conditions improve and menarche get earlier and earlier, uterine leiomyoma patients tend to be increasingly younger. At present, treatment of uterine myoma patients with symproms mainly use surgical operation. For females who have fertility requirements or require retaining integrity of the uterus, myomectomy is the preferred choice. A myomectomy can be performed in a number of ways, including laparoscopic myomectomy (LM), abdominal myomectomy (AM) and hysteroscopic myomectomy (HM). Laparoscopy is a minimally invasive surgery developed in recent years with less pain, smaller incision, smaller scar, quicker patient recovery, and other advantages and it has becoming more and more popular. With rapid development of laparoscopy minimally invasive technology and improvement of operation technology of operator, laparoscopic myomectomy is widely carried out in medium hospital in our country, and researches on its clinical treatment effect also gradually increase. However, research results differ. There was one research showed that, compared with AM, LM has advantage of less bleeding during procedure, and short procedure time. There's no difference of myoma recurrence and the pregnancy risk (uterine rupture) after the operation between AM and LM. However, other researches have totally different conclusions. It has been reported that, compared with AM, LM has prolonged operative time, does not always decrease intraoperative bleeding, and significantly increased myoma recurrence and pregnancy risk (uterine rupture) after the operation. It is necessary to further study the treatment effects of above mentioned two kinds of operation. There is much less reports on health economic study of AM and LM and more research are needed. Such researches can greatly benefit uterine leiomyoma patients in terms of selection of operation method according to their specific circumstances and economic conditions. Laparoscopic surgery has been performed for many years in our hospital. Here we report its therapeutic efficacy and health economics analysis.ObjectiveStudy the treatment effects of laparoscopic myomectomy and abdominal myomectomy and analyze their health economics.Evaluate the effects, advantages and economics of laparoscopic myomectomy.MethodA retrospective analysis of the clinical data of 220 myomectomy conducted in Puyang People's Hospital from January 2013 to December 2013. The ages of patients ranges from 26 to 45 years old. All patients are pathologically diagnosed as uterine leiomyoma. In accordance with the inclusion criteria and exclusion criteria, they were divided into two groups:laparoscopic group (120 cases) and laparotomy group (100 cases). The volume of bleeding during operation, operation time, numbers of myoma found during operation, days of postoperative hospitalization, and perioperative complications were compared between the two groups. Menstrual recovery, recurrence, postoperative pregnancy and pregnancy risk (uterine rupture) were followed up at 3 months,6 months, 12 months, and 24 months after the operations. For health economics analysis, we compared the direct medical costs, direct non-medical expenses, related work time-off cost as well as the total cost of the two groups.ResultsBleeding volume (86.1 ± 16.6 ml vs 108.2 ± 24.4ml), duration of surgery (99.1 ± 19.5 min vs 110.1 ± 21.5min), and postoperative hospitalization (5.3 ± 1.2 days vs 6.9 ± 1.5 days) of the laparoscopic group were significantly lower than that of the laparotomy group, respectively (all P<0.05). There's no significant difference in numbers of removed fibroids during operation between the laparoscopic group and the laparotomy group (1.6 ± 1.3 vs 1.7 ± 1.5, P> 0.05). There's no serious complications such as pelvic big vascular of injury, bowel injury, bladder and the ureteral injury in both groups during operations. Complications after operation include skin gas swollen (1 case), vaginal bleeding (1 case) (complications rate 1.7%) in laparoscopic group, and include ileus (1 case), incision infection (1 case) and vaginal bleeding (1 case) (complications rate for 3%). The complications rates between the two groups have no statistical difference (P> 0.05). There's no significant difference in menstruation return rate between the two groups (laparoscopic group 93.8%, laparotomy group 92.3%, P> 0.05) 24 months after operation. The recurrence rate of the laparoscopic group (12.5%) is much higher than that of the laparotomy group (4%) (P< 0.05). For patients who required fertility, pregnancy rates in laparoscopic group is 63.3% and uterine rupture occurred in 1 case (1.8%). Rate of pregnancy in laparotomy group is 65%. Uterine rupture occurred in 1 case (1.9%). There's no significant difference in rate of pregnancy and uterine rupture between the two groups (P> 0.05, respectively).Direct medical costs of the laparoscopy group (8349.2 ± 719.6 Yuan) is significantly higher than that of the laparotomy group (7438.7 ± 708.9 Yuan) (P< 0.05); Direct non-medical costs (579.3 ± 120.3 Yuan) and time costs (1458.5 ± 262.6 Yuan) of laparoscopy group were significantly lower than of the laparotomy group (669.2± 118.1 Yuan and 2246.7 ± 271.2 Yuan, respectively) (both P< 0.05). There's no significant difference in total medical expenses between the two groups (laparoscopic group, 10387.0 ± 102.5 Yuan vs laparotomy group,10354.6 ± 1098.2 Yuan) (P> 0.05).Conclusion1. Compared with abdominal myomectomy, laparoscopic myomectomy has advantage of less blood loss during operation, shorter surgery time, and shorter postoperative hospitalization time. Myoma recurrence rate after operation of the laparoscopic group is higher than that of the laparotomy group. There are no significant differences between the two groups in number of removal fibroid, postoperative complications, postoperative period return, pregnancy after operation and the risk of uterine rupture.2. Direct medical costs of the laparoscopic group is higher than that of the laparotomy group, but direct non-medical costs and time costs of laparoscopic group are lower. Total medical expenses for the two groups have no significant difference. Laparoscopic myomectomy does not increase the financial burden on patients. |
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