三叉神经痛患者不同手术方式的成本效益分析

Cost-benefit analysis of different surgical methods in patients with trigeminal neuralgia

目的分析药物控制不佳且从未接受过外科手术治疗的原发三叉神经痛患者通过手术[包括微血管减压术(MVD)、经皮射频神经根切断术(RFR)、立体定向放射治疗(SRS)]治疗后的花费-收益比。方法回顾性分析2005-2013年89例首次接受外科手术治疗的原发三叉神经痛患者(其中行MVD 27例,行RFR 23例,行SRS 39例)。评判标准(效果因数)包括面部疼痛(极佳:没有面部疼痛且无药物治疗;佳:没有面部疼痛但有药物治疗;欠佳:有面部疼痛但小于50%;差:≥50%的患者有面部疼痛或者需行二次手术)、面部麻木、花费等。结果接受手术患者的平均年龄:MVD(50.4±14.3)岁,RFR(73.2±13.6)岁和SRS(72.6±11.8)岁,3组比较差异有统计学意义(P<0.05);每种手术方式平均花费金额:MVD 50 274元,RFR 4 539元,SRS 38 512元(P<0.05);术后面部麻木患者的比例MVD 1.1%,RFR 52.2%,SRS 28.2%(P<0.05);两年内复发需要再次手术的患者比例MVD 26.0%,RFR 73.9%,SRS 30.7%(P<0.05);平均疼痛完全缓解期MVD为1.6年,RFR为2.1年,SRS为1.0年(P<0.05);花费-收益比MVD为31 618元,RFR为1 982元,SRS为39 297元(P<0.05)。结论 3种手术方式花费-收益比从低到高为RFR、MVD、SRS,即单位花费中RFR获得收益最高,其次是MVD和SRS。

Objective To analyze the cost-benefit ratio of primary trigeminal neuralgia patients with bad drug control and never accepted the surgical treatment through surgery[including microvascular decompression（MVD）,percutaneous radiofrequency rhizotomy（RFR）,stereotactic radiotherapy（SRS）].Methods A total of 89 patients with primary trigeminal neuralgia who underwent surgical treatment for the first time from 2005 to 2013 were enrolled in this study,including 27 patients with MVD,23 patients with RFR and 39 patients with SRS.Evaluation criteria（effect factors）include facial pain（excellent：no pain and no drug treatment;good：no pain but medication;worse：less than 50% of patients with pain;worse：more than 50% of patients with facial pain or need to undergo secondary surgery）,numbness,cost and.Results The mean age of the patients treated with MVD was（50.4±14.3）years old,RFR was（73.2±13.6）years old SRS was（72.6±11.8）years old,MVD group was younger than RFR and SRS group（P〈0.05）;The average total cost of each surgical approach as follows：MVD was 50 274 yuan,RFR was 4 539 yuan,SRS was 38 512 yuan（P〈0.05）;The postoperative facial numbness proportion of MVD was 1.1%,RFR was 52.2% and SRS was28.2%（P〈0.05）;The ratio of patients who needed recurrent surgery in two years was MVD 26.0%,RFR 73.9% and SRS30.7%（P〈0.05）;The mean remission rate of MVD was 1.6 years,the RFR was 2.1 years,and the SRS was 1.0 year（P〈0.05）;The cost-benefit ratio of MVD was 31 618 yuan,RFR was 1 982 yuan,SRS was 39 297 yuan（P〈0.05）.Conclusion The cost-benefit ratio of the three surgical from low to high were RFR,MVD,SRS,which means the unit cost of RFR gain the highest,followed by MVD and SRS.