机器人扁桃体切除术治疗良性疾病的卫生技术评估：一项回顾性队列研究中的临床结局与经济评价
Health technology assessment of robotic tonsillectomy for benign disease: clinical outcomes and economic evaluation in a retrospective cohort study.
文献信息
| PMID | 42966805 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Alberto José Guillén Martínez |
| 作者单位 | Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Los Arcos del Mar Menor, San Javier, Murcia, Spain. ajguillen@ucam.edu. |
| 期刊 | European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery |
| SCI 分区 | Q1 |
| IF | 2.3 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 机器人辅助手术在口咽恶性肿瘤中已有明确地位，但其在良性扁桃体疾病中的价值仍未被探索。本研究比较了机器人辅助扁桃体切除术与传统电灼扁桃体切除术在成人良性扁桃体疾病患者中的临床结局和直接医疗费用。
方法： 这项回顾性队列研究纳入了2025年4月至12月期间在西班牙一家三级转诊医院连续接受双侧扁桃体切除术的60例成年患者（30例机器人手术，30例传统电灼手术）。主要结局为需要医院评估或住院的术后出血。从公共医疗系统角度进行了经济评价，包括机会成本分析。
结果： 接受机器人手术的患者显著更年轻（24.2岁 vs. 36.8岁；p = 0.005）。机器人扁桃体切除术后术后出血显著更常见（30.0% vs. 6.7%；相对风险4.50，95% CI 1.06-19.11；p = 0.042），并且在多变量分析中仍与机器人手术独立相关（校正OR 6.39，95% CI 1.04-39.21；p = 0.045）。机器人手术还与更长的住院时间（3.27天 vs. 1.41天；p = 0.007）和更高的再入院率（50.0% vs. 16.7%；p = 0.013）相关。机器人手术的平均直接住院费用显著更高（每例患者€8,290.30 vs. €3,175.03；p < 0.001），代表一种被支配的医疗技术，具有相当大的机会成本。
结论： 与传统电灼扁桃体切除术相比，机器人辅助扁桃体切除术治疗良性疾病与更差的临床结局和显著更高的费用相关，目前不能推荐其常规实施。
英文摘要
PURPOSE: Robotic-assisted surgery has an established role in oropharyngeal malignancy, but its value in benign tonsillar disease remains unexplored. This study compared clinical outcomes and direct healthcare costs between robotic-assisted and conventional electrocautery tonsillectomy in adults with benign tonsillar disease.
METHODS: This retrospective cohort study included 60 consecutive adult patients undergoing bilateral tonsillectomy (30 robotic, 30 conventional electrocautery) at a tertiary referral hospital in Spain between April and December 2025. The primary outcome was postoperative haemorrhage requiring hospital assessment or admission. An economic evaluation, including an opportunity-cost analysis, was conducted from the perspective of the public healthcare system.
RESULTS: Patients undergoing robotic surgery were significantly younger (24.2 vs. 36.8 years; p = 0.005). Postoperative haemorrhage was significantly more frequent after robotic tonsillectomy (30.0% vs. 6.7%; relative risk 4.50, 95% CI 1.06-19.11; p = 0.042) and remained independently associated with robotic surgery on multivariable analysis (adjusted OR 6.39, 95% CI 1.04-39.21; p = 0.045). Robotic surgery was also associated with longer hospital stay (3.27 vs. 1.41 days; p = 0.007) and higher readmission rates (50.0% vs. 16.7%; p = 0.013). Mean direct hospital cost was substantially higher with robotic surgery (€8,290.30 vs. €3,175.03 per patient; p < 0.001), representing a dominated healthcare technology with considerable opportunity costs.
CONCLUSION: Robotic-assisted tonsillectomy for benign disease was associated with worse clinical outcomes and substantially higher costs than conventional electrocautery tonsillectomy, and its routine implementation cannot currently be recommended.