腹腔鏡下虫垂切除術の検討―臨床成績と医療経済からみた開腹手術との比較―

Evaluation of laparoscopic appendectomy : comparison of clinical outcomes and medical costs with open appendectomy

◆要旨：目的：2008年4月の診療報酬の改定で，腹腔鏡下虫垂切除術（以下，LA）の手術料が減額された．LAの治療成績，医療経済について検討する．対象と方法：それぞれ別の期間にLAを施行した145例と，開腹虫垂切除術（OA）を施行した152例とを治療成績と医療経済の面から比較検討した．結果：手術時間はLA群が長く，在院日数はLA群が短かった．創感染はLA群で皆無であった．遺残膿瘍発生率，再手術率，死亡率に差はなかった．総診療報酬点数はLA群が高かった．経費もLA群が高かった．手術1例あたりの収支はLA群が高かった．結語：臨床的にLAは安全で良好な治療成績をもたらした．診療報酬加算によるLAの普及が期待される．

　Background : Laparoscopic appendectomy（LA）has been estimated to reduce the postoperative pain, complications, and hospital stays compared with open appendectomy（OA）. However, LA has not been popular yet in Japan. We have been performing LA since 2002 and have accumulated satisfactory results. Revision of the medical fee in Japan was performed in April 2008, and the surgical fee of LA was decreased. We evaluated LA not only clinically but also economically. Methods : One hundred and forty five patients who underwent LA from July 2005 to June 2007 were compared with 152 patients who underwent OA from January 2000 to December 2001 for clinical outcomes and medical costs. A trial calculation of surgical expenses of LA and OA was performed and the validity of the official surgical fee was examined. Results : LA significantly prolonged the operation time and shortened the hospital stays. No wound infection was confirmed in LA patients. There was statistically no difference in the rate of residual abscesses, second operations, and mortality between LA and OA. The total fee of LA was higher than OA, but when limited to the serious cases with abscess or peritonitis, this difference became not significant. Expenses of LA were higher than OA, but profits did not decrease as the result of increased surgical and anesthetic fees. Conclusions : Clinical results of LA have been better than OA, so we hope it will become more popular in Japan by the addition of the surgical fee and the effort of cost reduction.