中国实用外科杂志

中国实用外科杂志

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腹主动脉瘤腔内治疗与传统开放手术卫生经济学对比研究

胡    明，杨    晗，覃    晓   

  1. 广西医科大学第一附属医院血管外科，广西南宁530021
  • 出版日期:2017-12-01 发布日期:2017-11-30

  • Online:2017-12-01 Published:2017-11-30

摘要：

目的    对腹主动脉瘤传统开放手术与腔内支架治疗的经济学效益进行系统评价，为腹主动脉瘤治疗方法的选择提供卫生经济学参考。方法    通过检索CENTRAL（Cochrane Library）、Ovid MEDLINE、EMBASE、ACP（American College of Physicians） Journal Club、中国学术期刊全文数据库（CNKI）、中国生物医学文献数据库（CBMdisc）、中文科技期刊全文数据库（VIP），根据纳入和排除标准，纳入2016年4月以前已经完成、正在进行或已经发表的腹主动脉瘤腔内治疗和传统开放手术治疗的临床随机对照试验以及非随机对照试验。结果    计算机检索和手工检索共初检出相关文献251篇，根据纳入和排除标准进行筛选，最终纳入4项已发表完成的随机对照试验以及12项非随机对照试验。结论    在植入物（支架或人工血管）费用、直接费用、医疗耗材方面，腔内治疗组均明显高于传统手术组；在随访、复诊费用、手术室使用费用、术前费用和手术费用方面差异不明显，而在重症监护室（ICU）和病房费用、工作人员费用、药物及血液费用方面，腔内治疗组明显低于传统手术组。由于各试验基线不尽一致，各文献年份前后相差较大，且未考虑通货膨胀、货币汇率等因素。期待更多设计合理、执行严格、大样本、多中心的随机对照试验，特别是适合本国国情的试验以指导临床实践。

关键词: 腹主动脉瘤, 腔内治疗, 开放手术, 经济效益, 系统评价

Abstract:

Cost-effectiveness of open versus endovascular repair of abdominal aortic aneurysms：A systematic review                 HU Ming，YANG Han，QIN Xiao. Department of Vascular Surgery，the First Affiliated Hospital of Guangxi Medical University，Nanning 530021，China
Corresponding author：QIN Xiao，E-mail：dr_qinxiao@163.com
Abstract    Objective    To evaluate therapeutic effectiveness of OR and EVAR of AAA and the difference of the cost effectiveness. Methods    The Cochrane Central Register of Controlled Trials （the Cochrane Library）,Ovid MEDLINE， EMBASE， ACP （American College of Physicians） Journal Club， CNKI， CBMdisc， Chinese Science and Technology Periodical Full Text Database （VIP）were retrieved. According to the inclusion and exclusion criteria， randomized controlled clinical trials and non randomized controlled experiment about endovascular treatment and traditional open surgical treatment of AAA which have been completed，ongoing or published before 2016 April were studied. Results    A total of 251 papers were found; 4 published randomized controlled trials and 12 non randomized controlled trials about the effectiveness and cost of AAA repair were pooled in the end. Conclusion    The costs of the implant （stent or graft）， direct costs， medical / surgical supplies of endovascular treatment group are significantly higher than those of the conventional surgery group；the difference of the costs of following-up， consultation fees， operating room cost， preoperative cost and operation cost between two groups are not obvious， and in ICU and Ward costs， staff costs，costs of drugs and blood， endovascular treatment group was significantly lower than those of the conventional surgery group.

Key words: abdominal aortic aneurysm, endovascular aneurysm repair, open repair, cost effectiveness , systematic review