介入与外科手术治疗症状性肝海绵状血管瘤的成本效益分析  

The cost-effect analysis of interventional and surgical therapy for symptomatic cavernous hemangioma of liver

作　　者：曾庆乐[1] 陈勇[1] 赵剑波[1] 张克伟[1] 李彦豪[1] 

机构地区：[1]南方医科大学南方医院介入治疗科,广州510515

出　　处：《介入放射学杂志》2009年第2期93-96,共4页Journal of Interventional Radiology

摘　　要：目的比较症状性肝海绵状血管瘤(SCHL)平阳霉素碘油乳剂动脉内硬化性栓塞(PLE-IASE)治疗和外科手术治疗对肝功能损害、治疗并发症、住院天数和住院费用等参数,确定两种治疗方法的差异,为SCHL治疗模式的选择提供依据。方法同期147例SCHL患者分为栓塞和手术两组。其中栓塞组89例行PLE-IASE,手术组58例行外科手术治疗。所有患者术前及术后3～7d行肝功能(ALT、AST、TBIL、IBIL、TP及ALB)检查。统计比较两组治疗前后肝功能变化,两组住院时间及住院经费的差异。观察近、远期并发症发生情况,统计比较两组并发症发生率之间的差异。结果栓塞组和手术组术前肝功能相比差异无统计学意义(P>0.05)。术后肝功能结果比较,栓塞组ALT、AST、TBIL升高和TP、ALB降低水平比手术组明显,差异有统计学意义(P值依次为0.000、0.014、0.004、0.000及0.000)。栓塞组住院期间有1例发生近期并发症。手术组住院期间12例发生并发症,其中轻微并发症10例,严重并发症2例。两组均未发生与处理因素有关的远期并发症。栓塞组并发症发生率为1.1%,手术组为20.7%,两组并发症发生率差异有统计学意义(P=0.000)。栓塞组住院时间平均为(8.0±3.5)d,手术组为(19.0±5.0)d,两组住院时间差异有统计学意义(P=0.000)。栓塞组住院经费平均为(13612.7±5860.5)元,手术组为(26335.6±8314.0)元,两组住院经费差异有统计学意义(P=0.000)。结论与外科手术治疗相比,动脉内PLE-IASE治疗SCHL,肝功能损伤小,并发症少,住院时间短,住院经费低,过程更加安全,成本-效益比更优。Objective Through comparing the damage of hepatic function, occurrence of complications, hospitalization days and medical expense between PLE-IASE therapy and surgical management for symptomatic cavernous hemangioma of liver to provide theoretical guidance in selecting proper treatment for this disease. Methods One hundred and forty-seven patients were randomly divided into PLE-IASE embolization group （n = 89） and surgery group （n = 58）. Before and 3 - 7 days after the treatment liver function, including ALT, AST, TBIL, IBIL, TP and ALB, was tested in all patients. The differences in the liver function data between two groups were statistically analyzed. The hospitalization days and medical expense of two groups were also recorded and compared. The complication occurrence of both short-term and long-term was observed, and the results in two groups were compared. Results No significant difference in liver function was found between two groups before the treatment. After the treatment, the increase of ALT, AST and TBIL in embolization group was significantly lower than that in surgery group, with P value being 0.000, 0.014 and 0.004 respectively. The decrease of TP and ALB in embolization group was also lower than that in surgery group （both P = 0.000）. During hospitalization, complication occurred in one case in embolization group and in 12 cases in surgery group, of which mild complication was seen in 10 and serious complication in 2. No treatment-related complications occurred in long-term observation in neither of the groups. The complication occurrence in embolization group and surgery group was 1.1% and 20.7% respectively, with a significant difference between two groups （P = 0.000）. The mean hospitalization days and medical expense in embolization group were （8.0 ± 3.5） days and ￥ （13 612.7 ±5 860.5） respectively, while in surgery group were（19.0 ± 5.0） days and ￥ （26 335.6± 8 314.0） respectively, with significant difference （both P = 0.000）. Conclusion For the tre

关 键 词：治疗 介入性 外科手术 肝海绵状血管瘤 成本-效益分析 

分 类 号：R735.7[医药卫生—肿瘤]