肺癌合并慢性阻塞性肺病和手术方式对患者术后快速康复及治疗费用的影响

目的探索影响肺癌患者术后快速康复的相关临床因素及治疗费用，探讨术后快速康复的临床途径及其临床价值。方法回顾性分析华西医院同一医疗组从2010年1月至2011年3月的所有入院，连续129例行肺癌切除术患者的临床资料。按是否合并慢性阻塞性肺疾病将患者分为合并慢性阻塞性肺病组COPD组，53例，其中男39例、女14例，平均年龄（56．3l±10．51）]岁和非慢性阻塞性肺病组非COPD组，76例，其中男37例、女39例，平均年龄（65．92±7．85）]岁；根据手术方式不同将患者分为全胸腔镜手术组（VATS组，83例，其中男44例、女39例，平均年龄（61．62±10．80）]岁和开胸组46例，其中男32例、女14例，平均年龄（62．95±9．97）]岁；分析不同组患者的术后并发症发生率、平均住院时间及各项费用。结果COPD组和非COPD组术后并发症发生率（53％VS．40％，P=0．134）和平均住院时间（7．66±2．95）dVS．（7．36±2．74）d，P=0．539]差异均无统计学意义。VATS组术后并发症发生率（34％VS．65％，P〈0．001）和平均住院时间（6．67±2．52）dVS．（8．6l±3．01）d，P〈0．001]均低于开胸组，且差异有统计学意义。VATS组平均住院总费用（44542．26±11447．50）元VS．（23634．13±6014．35）元，P〈0．001]和材料费（37352．53±11807．81）元VS．（12763．08±7124．76）元；P〈0．001]均显著高于开胸组，且差异有统计学意义。VATS组平均西药费显著低于开胸组（7473．54±4523．70）元VS．（10176．7l±6371．12）元，P〈0．001]，而两组其它费用差异均无统计学意义。结论VATS肺癌肺叶切除术可以促进术后快速康复，但增加了手术材料费用。而肺癌患者合并COPD与术后快速康复及费用均无关。

Impact of Chronic Obstructive Pulmonary Disease and Surgical Approach on Postoperative Fast Track Recovery andHospitalization Cost of Patients Undergoing Lung Cancer Resection

Objective To investigate the impact of chronic obstructive pulmonary disease （COPD） and surgical approach on postoperative fast track recovery and hospitalization cost of patients undergoing lung cancer resection, and explore clinical pathways and clinical value of fast track recovery. Method Clinical data of 129 consecutive patients undergoing lung cancer resection by one surgical group in West China Hospital from January 2010 to March 2011 were retrospectively analyzed. According to whether the patients had concomitant COPD, all the patients were divided into COPD group including 53 patients （ 39 males and 14 females ） with their average age of 56.31± 10.51 years, and non-COPD group including 76 patients （37 males and 39 females）with their average age of 65.92± 7.85 years. According to different surgical approaches, all the patients were divided into complete video-assisted thoracoscopic surgery （VATS） group including 83 patients （44 males and 39 females） with their average age of 61.62 ~ 10.80 years, and routine thoracotomy group including 46 patients （32 males and 14 females ）with their average age of 62.95± 9.97 years. Postoperative morbidity, average hospital stay and hospitalization cost were compared between respective groups. Results There was no statistical difference inpostoperative morbidity （53% vs. 40%, P=0.134） or average hospital stay （7.66± 2.95 ） days vs. （7.36± 2.74） days, P= 0.539 ] between COPD group and non-COPD group. Postoperative morbidity （34% vs. 65%,P 〈 0.001 ）and average hospital stay （6.67 ± 2.52 ） days vs. （ 8.61 ±3.01 ） days, P 〈 0.001 ] of VATS group were significantly lower or shorter than those of routine thoracotomy group. Total hospitalization cost 44 542.26± 11 447.50 yuan vs. 23 634.13±6 014.35 yuan, P 〈 0.001 ） and material cost 37 352.53 11 807.81 yuan vs. 12 763.08±7 124.76 yuan, P 〈 0.001 ） of VATS group were significantly higher than those of routine thoracotomy group. Average medication cost of VATS group was significantly lower than that of routine thoracotomy group 7 473.54± 523.70 vs. 10 176.71 ±6 371.12, P 〈 0.001 ）. There was no statistical difference in other cost between VATS group and routine thoracotomy group. Conclusion VATS lobectomy can promote postoperative fast track recovery of lung cancer patients, but also increase material cost of the surgery. COPD history does not influence postoperative fast track recovery or hospitalization cost.