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| 題 名 | 探討軟式輸尿管鏡碎石手術與經皮腎造瘻腎臟碎石手術之醫療品質與健保資源耗用分析=Investigation and Analysis of Medical Quality and Health Insurance Consumption between Retrograde Intrarenal Surgery and Percutaneous Nephrolithotomy |
|---|---|
| 作 者 | 蔡麗君; 吳靜華; 吳美珠; 李永進; 宋俊諺; 陳慧凌; 周淑婷; 王乙茜; 耿俊閎; | 書刊名 | 澄清醫護管理雜誌 |
| 卷 期 | 20:4 2024.10[民113.10] |
| 頁 次 | 頁17-25 |
| 分類號 | 416.276 |
| 關鍵詞 | 軟式輸尿管鏡碎石手術; 經皮腎造瘻腎臟碎石手術; 醫療品質; Retrograde intrarenal surgery; RIRS; Percutaneous nephrolithotomy; PNL; Medical quality; |
| 語 文 | 中文(Chinese) |
| 中文摘要 | 目的 本研究旨在探討軟式輸尿管鏡碎石手術與經皮 腎造ཝ腎臟碎石手術的健保醫療資源耗用、手術後 併發症及手術後滿意度成效。 方法 運用病歷回溯描述性研究,收集 2019 年1月至 2022 年 8 月,高雄某區域醫院資料庫接受腎臟結石 碎石手術之住院病人病歷資料共 60 位。研究資料 分為軟式輸尿管鏡碎石手術(RIRS)與經皮腎造ཝ 腎臟碎石手術(PNL),RIRS 為利用可重複使用的 軟式輸尿管鏡組,包含自費項目 3-5 萬元,至於 PNL 為健保手術,不含自費項目。我們對這兩種手術方 式,進行健保醫療資源耗用、手術後併發症及手術 後滿意度的分析。 結果 PNL 手術醫療費用高於 RIRS 手術(p<0.001) 花費手術時間無差異(p=0.44)RIRS 手術在手術 中出血量(p=0.002)、手術後 Hb 下降(p<0.001) 低於 PNL 手術PNL 手術併發症發燒 10%、敗血 症 3.3%,而 RIRS 則無發燒或敗血症手術後第一 次下床時間、手術後 12 小時的疼痛程度及平均住 院日,RIRS 手術都顯著低於 PNL 手術(p<0.001), 醫療照護整體滿意度 RIRS 手術顯著高於 PNL 手 術(p<0.001),在結石殘餘狀況,RIRS 的 Stone-free 為 86%,至於 PNL 為 63%,但因為本研究沒有校 正結石之大小、位置及數量,尤其 PNL 常常用在 處理更為複雜的結石,所以難以比較優劣,還需其 他研究設計來探討。 結論 RIRS 手術自費項目會造成病人的負擔不論有否 私人保險,但在平均住院日下降,手術後恢復快,維 持病人醫療照護品質、節省健保支出及增加醫院收益 等好處,本研究希望藉由這些指標數據,提升病人醫 療品質與醫院效益,而達到雙贏的局面。 |
| 英文摘要 | Purposes This study is intended to investigate the differences in health insurance and medical resource consumption, postoperative complications, and postoperative satisfaction between retrograde intrarenal surgery and percutaneous nephrolithotomy. Methods A retrospective comparative study was conducted on the inpatient medical records of 60 patients who underwent nephrolithotripsy surgery in a Kaohsiung regional hospital between January 2019 and August 2022. The research data were categorized based on the surgical procedure: retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL). The RIRS group utilized reusable flexible ureteroscopy and included a patient self-funded component of NT$30,000 to NT$50,000, while PNL is fully covered by health insurance. The study analyzed the consumption of health insurance and medical resources, postoperative complications, and postoperative satisfaction for these two surgical methods. Results The medical cost of PNL was higher than that of RIRS (p<0.001). No significant difference was observed in the operation duration (p=0.44). RIRS had lower bleeding volume during surgery (p=0.002) and a lower decrease in Hb post-surgery (p<0.001). PNL surgery complications included fever (10%) and sepsis (3.3%), while RIRS had no postoperative complications. Time taken to get out of bed for the first time post-surgery, 12 hours post-surgical pain score, and average length of stay were significantly lower for RIRS than for PNL (p<0.001). Overall medical care satisfaction with RIRS was significantly higher than for PNL (p<0.001). In addition, RIRS was 86% stone-free, while PNL was 63% stone-free. However, due to the lack of adjustment for stone size, location, and number, further research is required to determine which procedure is superior. Conclusions The self-financing aspect of RIRS surgery might pose a burden on patients, regardless of insurance coverage, but it reduces the average length of stay, expedites post-surgery recovery, maintains the quality of care for patients, saves health insurance expenditure, and increases hospital revenue. This study is intended to achieve a win–win situation, by utilizing these findings to enhance patient care quality and healthcare institution efficiency. |
本系統中英文摘要資訊取自各篇刊載內容。