開顱手術或血管內栓塞治療顱內動脈瘤破裂之醫療耗用比較

Medical utilization of endovascular versus neurosurgical treatment for ruptured intracranial aneurysms in Taiwan

黃炳生(Bing-Sang Wong) ； 陳秀敏(Hsiu-Min Chen)

《安泰醫護雜誌》 22卷1期 (2016/06) Pp. 1-12

摘要

研究背景與目的：「顱內動脈瘤」可用外科手術經由外部治療或使用微創介入性治療由血管內部來著手，本研究目的在進行此兩類手術之評估。方法：本研究為使用回溯性次級資料分析之橫斷性研究。對象為全國醫學中心自2004年1月1日至2007年12月31日止，在健保所申報此兩類手術民眾的資料。統計軟體是SPSS 14.0，顯著水準設為0.05。結果：結果顯示在手術併發症上，以血管內栓塞來治療腦動脈瘤破裂比以傳統開顱手術少，發生機率約為傳統手術的50% (p = 0.038)。在住院天數方面，以血管內栓塞治療可平均縮短病患住院7.8天。但在死亡率與總醫療費用上兩者並無明顯差異。結論：根據本研究結果提供醫療政策制訂者在擬定血管內栓塞手術之健係給付及規範方向與醫療服務提供者在腦動脈瘤病患選擇手術方式之參考。

關鍵字

顱內動脈瘤 ； 開顱手術夾手術 ； 血管內栓塞 ； 白金纖維環 ； 醫療耗用

並列摘要

Objectives and Purposes: Cerebrovascular disease ranks the third leading cause of death in Taiwan. Ruptured intracranial aneurysm is one of the main factors of hemorrhagic stroke. Aneurysm surgery can be done by traditional craniotomy with external clipping of the aneurysm. Recently, study of relevant literature review that a new surgical treatment of intracranial aneurysm by using minimally invasive intravascular embolization may provide patients with better outcome and shorter recovery time. However, the National Health Insurance Administration restricted the use of these platinum coils clinically. The purpose of this study is to compare these two types of procedures in their clinical outcomes and medical utilizations. Methods: According to the current literature of intracranial aneurysms treatment, we divided the traditional craniotomy surgery and endovascular surgery into two categories. This study was a cross-sectional, retrospective secondary data analysis. We obtained data from the National Health Insurance Database. Patients were eligible for the study if they harbored a ruptured intracranial aneurysm that received either technique (surgical or endovascular) in medical centers from January 1, 2004 to December 31, 2007. The following data were obtained from the Database: age, sex, surgical costs, total medical utilization, the length of stay, complications, and mortality. By using SPSS 14.0 Chinese statistical software for statistical analysis, we validated of this hypothesis through statistical methods of descriptive statistics, independent sample t test, chi square test, one-way ANOVA, correlation analysis, linear and multiple regression analysis. Results: The results showed that complications of embolization group in the treatment of ruptured intracranial aneurysms was less than the traditional craniotomy group, the incidence is about half than the traditional surgery (OR = 0.515, p = 0.038). The length of stay in the embolization group had a reduction of 7.8 hospital days to an average. However, no significant difference was found in mortality and the total medical consumption cost. Conclusion: Cerebral aneurysm is a complex disease, the severity of patients varies from each another, greatly depends on the aneurysm size and location. Endovascular embolization is a new treatment technique. The effectiveness of this treatment still needs long-term follow-up. Current national preliminary study is encouraged, especially in some difficult aneurysm location where performing craniotomy is highly risky. The results of this study can provide health care policy makers some specifications and direction in the formulation of endovascular surgery, and to the health care providers, the treatment of choices while facing ruptured intracranial aneurysm.

並列關鍵字

Intracranial aneurysm ； craniotomy surgery ； endovascular embolization ； Platinum coil ； medical utilization