《未破裂动脉瘤的治疗》课件.ppt

未破裂动脉瘤治疗的性价比分析 Treatment of Unruptured Intracranial Aneurysms： Decision and Cost-effectiveness Analysis Hidemasa Takao,MD，Takeshi Nojo, MD, MPH， Japan. Radiology: Volume 244: 3—September 2007 （Twelve clinical scenarios were defined on the basis of aneurysm size and location. Probabilistic sensitivity analyses were performed for 50- and 40-year-old patient cohorts. Treatment was considered to be cost-effective at an incremental costeffectiveness ratio less than $100 000 per quality-adjusted life-year.） . 未破裂动脉瘤治疗的性价比结果 In 50-year-old patients： No treatment was the most costeffective strategy for aneurysms located in the cavernous carotid artery. Located in the anterior circulation For aneurysms smaller than 7 mm no treatment was the most cost-effective strategy. 未破裂动脉瘤治疗的性价比结果 2. Endovascular treatment was the most cost-effective option for 7–24-mm aneurysms 3. Whereas surgical treatment was the most cost-effective option for aneurysms 25 mm or larger 未破裂动脉瘤治疗的性价比结果 Located in the posterior circulation For aneurysms smaller than 7 mm or 25 mm or larger no treatment was the most costeffective strategy. 2. Surgical treatment was the most costeffective option for 7–12-mm aneurysms 3. whereas endovascular treatment was the most cost-effective option for 13–24-mm aneurysms 国内各地区各单位技术水平发展非常不平衡，高水平和一般水平的医生共存，未破裂动脉瘤患者具备择期治疗的客观条件。未破裂动脉瘤应该让具有较高水平、较丰富临床经验、最好同时擅长手术和介入的治疗团队进行治疗。 治疗单位的选择  4、CTA筛查发现可直接治 建 议 颅内未破裂动脉瘤： 2、能治、可治的尽量治 3、术中一旦发现及早治 1、力争彻底治疗并安全 * 我们的最终目标是：建成一座国内领先、世界一流的现代化脑科医院。 第四军医大学唐都医院神经外科 颅 内未破裂动脉瘤治疗决策 第四军医大学唐都医院神经外科 高国栋 问 题 治 疗 观 察 VS ？ 治疗 观察 颅内动脉瘤危害： 破裂出血→再出血→致残、致死率高 未破裂动脉瘤： 造影时（多发）、CTA、MRA 简 单 的 思 考 左边：治疗的风险 右边：观察的风险 并发症和死亡率? 手术 破裂出血机率? 动脉瘤 复 杂 的 考 虑 治疗的并发症率和死亡率不确定 未破裂动脉瘤年破裂率不确定 患者生存的年限不确定 就某个具体病人而言： 世界性的难解之题 治好还是不治好 ？ Unruptured intracranial aneurysms-risk of rupture and risks of surgical intervention. N Engl J Med. 1998;339:1725–1733. 不 治 的 依 据 Unruptured intracranial aneurysms : na