王宗洪，周檎（什邡市人民医院普外科，四川618400）

低成本腹腔镜阑尾切除术在临床路径单病种限额付费中的可行性分析

王宗洪，周檎△
（什邡市人民医院普外科，四川618400）

目的评价低成本腹腔镜阑尾切除术在临床路径定额付费中的可行性。方法回顾性分析该院2015年1～11月进入临床路径行阑尾切除术的急性阑尾炎患者100例，将其随机分为研究组和对照组，各50例。研究组患者采用单极电凝行低成本腹腔镜阑尾切除术；对照组患者采用传统的开腹阑尾切除术。分别比较两组患者平均住院费用、平均住院时间、路径变异率和患者满意度。结果研究组平均住院时间和路径变异率明显减少，患者满意度明显提高，差异均有统计学意义（P＜0.05）。而两组平均住院费用比较，差异无统计学意义（P＞0．05）。结论采用单极电凝法低成本腹腔镜阑尾切除术在临床路径限额费用中应用是可行的，且在平均住院时间、路径变异率、患者满意度方面均优于传统开腹手术，值得在临床推广。

阑尾切除术；腹腔镜检查；临床路径；费用，医疗；电凝术

【Abstract】Objective To evaluate the feasibility of low-cost laparoscopic appendectomy in the clinicalpath way of single disease quota payment.M ethods A totalof100 cases ofacute appendicitis performing appendectomy by the clinicalpath way in ourhospital from January to November 2015 were retrospectively analyzed and random ly divided into the study group and the control group，50 cases in each group.The study group adopted the low-cost laparoscopic appendectomy bymonopolar electro coagulation，while the control group adopted the traditionalopen appendectomy.The average hospitalization costs，average hospitalization days，pathway change rate and patient′s satisfaction were compared between the two groups.Results Compared with the control group，the average hospitalization days and pathway change rate in the study group were significantly decreased，and the patient′ssatisfactionwassignificantly improved，the differences were statistically significant（P＜0.05），but the average hospitalization costshad no statistical difference between the two groups（P＞0.05）.Conclusion Adopting the low-cost laparoscopic appendectomy by themonopolar electro coagulation is feasible in the clinical path way of single disease quota pay，is superior to the traditional open appendectomy in the aspects of the average hospitalization time，pathway change rate and the patient′s satisfaction and deserves to be clinically promoted.

【Key words】Appendectomy；Laparoscopy；Criticalpathways；Fees，medical；Electrocoagulation

临床路径（clinicalpathway）指征对某一疾病建立一套标准化治疗模式与治疗流程，临床诊疗中按照此规范诊疗疾病，最终起到规范医疗行为、减少变异、降低成本、提高质量的作用［1］。近年来我国逐渐实施临床路径，效果良好。自本院开展急性阑尾炎临床路径以来，实行单病种限额付费，住院费用限额5 500元。传统开腹阑尾切除术（OA）患者住院费用基本能够在定额费用内完成；……