血管内栓塞与手术夹闭治疗前或后交通动脉破裂动脉瘤的效果和成本比较  

Comparison of outcome and cost of endovascular coiling versus surgical clipping in the treatment of ruptmed anterior or posterior communicating artery aneury sm aneurysms

作　　者：傅镁[1] 顾宇翔[1] 宋冬雷[1] 冷冰[1] 王启弘[1] 应晓华[2] 

机构地区：[1]复旦大学附属华山医院,上海200040 [2]复旦大学公共卫生学院,上海200032

出　　处：《国际脑血管病杂志》2011年第4期269-274,共6页International Journal of Cerebrovascular Diseases

摘　　要：目的比较手术夹闭与血管内介入治疗两种术式用于前、后交通动脉动脉瘤治疗的效果和成本，并进行成本效益分析。方法采用回顾性队列研究分析2002年至2006年期间华山医院收治的接受手术夹闭或介入治疗的前、后交通动脉动脉瘤患者治疗转归和花费等资料。结果共纳入302例患者，其中手术夹闭组150例[男性65例，年龄（48．11±9．94）岁]，介入治疗组152例[男性75例，年龄（52．56±11．09）岁]，前组年龄低于后组（t=-3．670，P=0．000）。两组患者术前临床情况，如动脉瘤位置、术前Hunt—Hess分级无显著差异。介入治疗组转归良好率显著高于手术夹闭组（84．87％对74．67％，x^2=4．875，P=0．027）。手术夹闭组院内病死率（5．33％对3．94％，矿=0．328，P=0．567）和并发症发生率（26．67％对19．74％，x^2=2．036，P=0．154））与介入治疗组无显著差异，但手术夹闭组术中动脉瘤破裂（10．67％对3．95％，x^2=5．047，P=0．028）和术后颅内感染发生率（6／144对0／152，x^2=6．203，P=0．014）高于介入治疗组。介入治疗组住院日显著短于手术夹闭组[（10．0±7．0）d对（23．0±11．0）d，Z=-10．35，P〈0．001]。介入治疗组治疗成本中位数为95327．63元，四分位间距为26312．98元；显著高于手术夹闭组（中位数30072．01元，四分位间距11178．54元）（Z=-14．449，P〈0．001）。与手术夹闭相比，介入治疗组mRS评分增高0．10分的成本约为66438元，手术夹闭更具成本效益。结论介入治疗前、后交通动脉动脉瘤的效果优于手术夹闭，病死率和总的并发症发生率与手术夹闭相当，住院时间更短，但治疗费用较高，从经济学考虑，手术夹闭更具成本效襦。Objective To compare the efficacy and cost of surgical clipping and endovascular embolization in the treatment of anterior and posterior communicating artery aneurysm and to conduct cost-effectiveness analysis. Methods The data of treatment outcomes and costs in patients with anterior or posterior communicating artery aneurysms admitted to Huashan hospital from 2002 to 2006 were analyzed using a retrospective cohort study. Results A total of 302 patients were included in the study. They were divided into surgical clipping group （n = 150; 65 males, age [48. 11 ±9. 941 years）, interventional treatment group （n = 152;75 males, age [ 52. 56 ± 11.09 ] year）. The age of the former was lower than that of the latter （t = -3. 670, P =0. 000）. There was no significant difference in preoperative clinical conditions （such as location of aneurysms and Hunt-Hess grade） between the two groups. The good outcome rate in the interventional treatment group was significantly higher than that in the surgical clipping group （84. 87% vs. 74. 67%, x^2 = 4. 875, P = 0. 027）. There was no significant difference in hospital mortality （5.33% vs. 3.94%,x^2 =0. 328, P =0. 567） and complication rate （26. 67% vs. 19. 74% ,x^2 =2. 036, P =0. 154） between the surgical clipping group and the interventional treatment group, but the intraoperative aneurysm rupture （10. 67% vs. 3.95%, x^2 = 5. 047, P =0. 028） and the incidence of postoperative intracranial infection （6/144 vs. 0/152, ,x^2 =6- 203, P =0： 014） in the surgical clippinggroup were higher than those in the interventional cratment group. The length of hospital stay in the interventional treatment group was signifi- cantly shorter than that in the surgical clipping group （[ 10. 0 ± 7.0] dvs. [23.0 ± 11.0] d, Z = - 10. 35, P 〈0. 001）. The median cost of treatment was 95 327. 63 yuan in the interventional treatment group, and the interquartile range （IQR） was 26 312. 98 yuan; it was significantly higher than the surgical clipping group （med

关 键 词：颅内动脉瘤 蛛网膜下腔出血 栓塞 治疗性 神经外科手术 费用效益分析 

分 类 号：R651.12[医药卫生—外科学]