【摘要】 目的：分析在按疾病诊断相关分组（DRG）付费模式下影响宫腔镜手术住院总费用的关键因素，为优化费用管控、促进资源合理配置提供依据。方法：回顾性收集2021年6月至2025年6月在广州市某医院行宫腔镜手术的3903例患者资料，以住院总费用为因变量，以年龄、术后诊断、手术方式等为自变量，进行单因素分析和多重线性回归分析。结果：3903例患者平均年龄（41.8±10.4）岁；单因素分析显示，不同年龄、不同病种和不同手术方式的费用比较，差异有统计学意义（P<0.001）；多元线性回归（调整后R~2=0.542）表明，手术方式是费用的最强预测因素，其中宫腔镜下子宫内膜/肌瘤电切术的费用较参照组增加153.2%；与<45岁组患者比较，45～60岁组患者费用显著降低6.9%；特定术后诊断（如异位妊娠、宫腔粘连）亦为费用的独立影响因素（P<0.05）。结论：在DRG支付背景下，宫腔镜手术住院总费用主要受手术方式的复杂性驱动，患者年龄及术后诊断也具有显著性影响。建议在DRG分组及权重设定中，更精细地考虑手术复杂性与患者特征，以建立更公平合理的补偿机制。更多还原

【Abstract】 Objective To analyze the key factors influencing the total hospitalization costs of hysteroscopic surgery under the diagnosis related groups(DRG) payment model, and to provide a basis for optimizing cost control and promoting the rational allocation of resources. Methods A retrospective collection of data from 3903 patients who underwent hysteroscopic surgery at a hospital in Guangzhou from June 2021 to June 2025 was conducted. The total hospitalization cost was taken as the dependent variable, and age, postoperative diagnosis, and surgical methods were taken as independent variables for univariate analysis and multiple linear regression analysis. Results The average age of the 3903 patients was(41.8±10.4) years. Univariate analysis showed that there were statistically significant differences in costs among different ages, different diseases, and different surgical methods(P < 0.001). Multiple linear regression(adjusted R~2 = 0.542) indicated that the surgical method was the strongest predictor of cost, with the cost of hysteroscopic endometrial/myoma resection increasing by 153.2% compared to the reference group. Compared with patients under 45 years old, those aged 45 to 60 years had a significant 6.9% reduction in costs. Specific postoperative diagnoses(such as ectopic pregnancy and intrauterine adhesions) were also independent influencing factors for costs(P < 0.05). Conclusion Under the DRG payment background, the total hospitalization cost of hysteroscopic surgery is mainly driven by the complexity of the surgical method, and the age of the patient and postoperative diagnosis also have significant influences. It is suggested that in the DRG grouping and weight setting, the complexity of the surgery and patient characteristics should be considered more precisely to establish a fairer and more reasonable compensation mechanism.更多还原