Study On The Influence Factors Of Prevalence And The Health Economics Of Surgical Therapy Methods Of Uterine Myomas In Fuzhou

[Objective]Research and analyze the influence factors of the child-bearing women who suffer from Uterine Myomas(UM) in Fuzhou city. Research the current status of treatment of UM. Research the influence factors of treatment options. Compare the therapy method from health economics.On the basis, putting forward the suggestions of UM's clinical path by Business Process Reengineering(BRP). To provide the scientific basis for the prevention and treatment of UM in local area. To provide the medical decision making for health workers. To provide the scientific basis for the surgical method options.[Method]First of all, to explore the possible pathogenesis of UM in local area by the case-control study.Using the questionnaire and scale to research the influence factors of the child-bearing women who suffer from UM from the top three hospitals in Fuzhou city. Then, analyze the influence factors of the child-bearing years women who from UM by the single factor analysis and the non-conditional logistic regression analysis.Second, using a questionnaire to research the clinical data and the surgical treatment of UM's surgical patient in the top three hospitals in Fuzhou city during 2014. On the basis, to analysis the influence factors of the operative approach and selection. To analysis the UM's high-risk groups from 40 to 50 years old by health economics. To put forward the preliminary idea of UM's clinical path by valueless period of hospitalization and BRP.[Result]In terms of UM's influence factors, the risk factors include the body mass index(BMI),emotion, psychological, diet preferences, abortion history, UM's family history. Results are shown below.1. Comparing with normal BMI, the OR of the groups whose BMI between 24 and 28 is2.637(95%CI 1.529~4.549), the OR of the groups whose BMI over 28 is 3.878(95%CI1.659~9.067).2. Comparing with normal emotion and psychological, the OR of the nondysphorics is4.101(95%CI 1.889~8.902), the OR of the mild dysphorics is 2.221(95%CI 1.304~3.782), the OR of the moderate dysphorics is 19.081(95%CI 2.476~57.617).3. Comparing with normal dietary habit, the OR of the meat-eaters is 1.729(95%CI1.108~2.699), the OR of the sweet-eaters is 1.913(95%CI 1.038~3.523).4. The OR of the groups who have the history of abortion is 1.653(95%CI 1.082~2.524). The OR of the groups whose abortion count over twice is 1.899(95%CI 1.122~3.215).5. The OR of the groups whose first-degree relative suffer from UM is 4.446(95%CI2.391~8.265).In terms of UM's influence factors, the protective factors include the menstrual history and childbearing history. Results are shown below.1. Comparing with the groups whose menarche age less than 16 years old, the OR of the groups whose menarche age more than 16 years old is 0.593(95%CI 0.393~0.895).2. Comparing with the groups whose pregnant times less than thrice, the OR of the groups whose pregnant times more than thrice is 0.577(95%CI 0.379~0.877).3. Comparing with the groups whose delivery times less than twice, the OR of the groups whose delivery times more than twice is 0.639(95%CI 0.422~0.967).In terms of UM's influence factors of choosing surgical methods, it concludes age,occupation, medical payments, childbearing history and hospital way. Results are shown below.1. Age. These senior age groups of women tend to choose the hysterectomy, while the junior age groups of women tend to choose the myomectomy(?2 ? 246.719,P<0.05).2. Occupation. The majority of housewife choose the hysterectomy, while the staff of state administrative organs and enterprises, individual businessman and service staff tend to choose the myomectomy(?2 ? 23.535,P<0.05).3. Medical payments. People who have the payments choose the hysterectomy, opposite choose the myomectomy(?2 ? 31.750,P<0.05).4. Childbearing history. People who don't have fertility repuirements choose the hysterectomy, opposite choose the myomectomy(?2 ? 27.382,P<0.05).5. Hospital way. The major of the mergency patients choose the hysterectomy, while others choose the myomectomy(?2 ? 32.835,P<0.05).Three kinds of operation all exist the valueless period of hospitalization by analyzing with health economic analysis. There is 54 cases have the valueless period of hospitalization from 62 cases of the laparoscopic assisted vaginal hysterectomy(LAVH)(87.1%). There is 281 cases have the valueless period of hospitalization from 326 cases of the laparoscopic supercervical hysterectomy(LSH)(86.2%). There is 286 cases have the valueless period of hospitalization from355 cases of the laparoscopic mectomy(LM)(80.6%).By removing the worthless hospitalization for business process restructuring, after the adjustment LAVH shorten hospitalization days from 12.63 days to 9.30 days, can be more than 23 patients admitted each, the treatment can increase the income ?5,7690.7. After the adjustment LSH shorten hospitalization days from 11.01 days to 8.54 days, can be more than 95 patients admitted each, the treatment can increase the income ? 29,9404.7. After the adjustment LM shorten hospitalization days from 10.66 days to 8.37 days, can be more than 98 patients admitted each, the treatment can increase the income ?38,6332.7.The three surgical treated increase more than 216 patients per year, and hospital revenue increase of ?74,3328.1.1. Overweight, obesity, anxiety, milddepression, severedepression, aborticide, abortionfrequency, first-degree-relatives-of-uterine-fibroids, meat, sweet are the prevalence of risk factors for uterine fibroids. Menarche over 16 age, gravidity over 3, parity over 2, are the uterine fibroids protection factor.2. In the surgical treatment of uterine fibroid, laparoscopic surgery has replaced traditional surgery. The influencing factors of three types of laparoscopic surgery were age, occupation,medical payment mode, birth history, and hospital admission.3. According to the current medical treatment path, the patient with uterine fibroids laparoscopic surgery were 83.5% exists worthless hospitalization. After the restructuring process,the three methods of laparoscopic operative, the average length of stay shortened 3.33 days,2.47 days and 2.29 days. The three surgical treated increase more than 216 patients per year, and hospital revenue increase of ?74,3328.1.