疑难性腹部疾病诊断的费用效果分析周曾芬1陈世耀2王吉耀21昆医附一院消化内科2上海医科大学附属中山医院消化内科摘要目的研究腹腔镜检查在诊断疑难性腹部疾病中的效率（即费用--效果）。方法将31例疑难性腹部疾病的诊断方法分四组：基础组，腹腔穿刺腹水检查和B超检查；增强CT组，增强CT检查；腹腔镜组，腹腔镜检查；联合组，以上方法联合检查。统计各组的确诊率；以云南省三级甲等医院收费标准，计算各组每确诊1例所需要的平均费用；与基础组相比后三组每增加1例确诊所需要增加的费用；并作敏感性分析。结果基础组、增强CT组、腹腔镜组和联合组的确诊率分别为2/31、6/31、30/31和30/31；每确诊1例平均费用分别为3348.90元、4511.43元、1455.49元、2124.14元；与基础组相比，每增加1例确诊，后三组所需要增加的费用分别为5092.70元、1320.25元、2036.65元。可见，腹腔镜组和联合组明显优于增强CT组，而且以腹腔镜组为最优。敏感性分析仍然支持本研究结果。结论疑难性腹部疾病进行腹腔镜检查可尽早明确诊断、及时治疗，其成本费用最少。关键词:腹腔镜检查腹腔穿刺检查影像学检查疑难病费用----效果分析中国图书分类号:573.2Acost-effectivenessstudyofdiagnosisbylaparascopyofdifficultandcomplicatedabdominaldiseasesZhouzengfenLushuanQinxingluCuirongDepartmentofGastroenterolong，theFirstAffiliaHospitalofKunmingMedicalCollege，Kunming，650032ChenshiyaoWangjiyaoDepartmentofGastroenterolong，zhongshanHospital，ShanghaiMedicalUniversity，Shanghai200032AbstractAimToassessthecost-effectivenessofdiagnosisbylaparascopyofdifficultandcomplicatedabdominaldiseases.MethodsThediagnosticmethodsofthe31casesofdifficultandcomplicatedabdominaldiseasesweredividedintofourgroups:abasicgroup（namely,repeatedascitestestsafterpunctureandultrasonography），aenhancedCTgroup，alaparatorygroupandaalliancegroupoftheabovementionedthreegroups．Thediagnosticrates,theaveragecostsperonecasewhichwascorrectlydiagnosedintheabovefourgroups,andhavingcomparedwiththebasedgroup,theincreasedcostsinthelatterthreegroupswhileaddedonecasewasdiagnosedcorrectlywerecalculatedrespectively..ThecostswerecalculatedaccordingtothestandardofⅢAgradehospitalsintheprovinceofYunnan.Sensitivityanalysisofthefourgroupswasmade,too.ResultsThediagnosticrateswere2/31,6/31,30/31and30/31;theaveragecostswere￥3348.90,￥4511.43,￥1455.49,and￥2124.12inthefourgroupsrespectively;havingcomparedwiththebasicgroup,theincreasedcostswere￥5092.72,￥1320.25and￥2036.65inthelatterthreegroupsrespectivelywhileaddedonecasewascorrectlydiagnosed.So,theefficiencyinthelaparatorygroupandthealliancegroupwasmoreexcellentthaninthebasicgroupandtheenhancedCTgroupandtheefficiencyinthelaparatory1groupwasthemostexcellentamongthefourgroups.Thesensitivityanalysisofthesematerialswasaccordantwiththisresult,too.Conclusionthedifficultandcomplicatedabdominaldiseasesshouldbediagnosedbylaparascopyasearlyaspossibledirectlysoastoobtaintheircorrectdiagnosesandtreatments.Andthecostofthelaparascopygroupwastheleastamongthefourgroups.KeywordsCost-effectivenessanalysisDifficultandcomplicatedabdominaldiseasesLaparascopyAscitestestsafterpunctureEnhencedCTscanning腹痛、腹水和腹块是临床常见征象，结合病史，体征和常规化验检查，大部分病人可获明确诊断，但仍有约1/3的病例难以诊断。对疑难性腹部疾病，目前主要依靠常规生化、腹水实验室、胃肠镜等检查，然而,甚至在进行了CT、MRI等影象学检查之后仍不能明确诊断。因此不明原因的腹痛、腹水、腹块的病因诊断一直是临床的一大难题[1]。腹腔镜检查由于技术的更新，能直接窥视到大部分壁、脏层腹膜，肝、胆、脾、胃肠、肠系膜、大网膜和盆腔，对病变典型部位直视下取材...
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