Nealon W H, Urrutia F, Fleming D, Thompson J C
Department of Surgery, University of Texas Medical Branch, Galveston 77550.
Ann Surg. 1991 Jun;213(6):645-9; discussion 649-50. doi: 10.1097/00000658-199106000-00015.
Gallstone lithotripsy (LITHO) was performed on 52 patients who underwent 107 procedures. Two hundred sixty-seven gallstone patients were screened and 215 (81%) were excluded. Excessive stone burden and nonvisualization by oral cholecystogram (OCG) were the most common reasons for exclusion. The hospital course of 100 excluded patients who later underwent elective cholecystectomy was evaluated for length of hospital stay (2.3 days) and total cost of treatment ($3685.00). Successful fragmentation to less than 5 mm was achieved in 43 LITHO patients (83%). Five LITHO patients (10%) required conversion to operative management. Complications of LITHO included acute cholecystitis (1 of 52 patients) and biliary colic (17 of 52 patients, or 33%). Multiple procedures in one patient were common. Costs for LITHO were calculated in two ways: first the individual cost for each of the 52 candidates; second the cost for successful LITHO was calculated by excluding five patients who required operation as well as five patients (10%) who are predicted failures of LITHO. Including the preoperative evaluation, treatment, recovery room, and follow-up, the individual LITHO cost for 52 patients was $8275.00. If the same total expenditure is calculated after excluding patients who required operation and those predicted to fail, the cost per 'successful' LITHO procedure was $10,245. The cost of 1 year of bile acid therapy is $1949.00 or $2413.00 per 'successful' procedure. Follow-up costs were $1232.00 per patient or $1525.00 per 'successful' procedure. The added LITHO cost incurred by screening eventual noncandidates was $904.00 per successful procedure. The sum of these individual costs was $15,087.00 per success, as compared to $3685.00 for cholecystectomy. No allowance was made for cost of stone recurrence. Lithotripsy costs appear to be sufficiently high to render the procedure unlikely to emerge as the treatment of choice.
对52例患者实施了107次胆结石碎石术（LITHO）。共筛查了267例胆结石患者，其中215例（81%）被排除。结石负荷过大和口服胆囊造影（OCG）未显像是最常见的排除原因。对100例后来接受择期胆囊切除术的排除患者的住院过程进行了评估，评估指标包括住院时间（2.3天）和治疗总费用（3685.00美元）。43例接受碎石术的患者（83%）成功将结石碎至小于5毫米。5例接受碎石术的患者（10%）需要转为手术治疗。碎石术的并发症包括急性胆囊炎（52例患者中的1例）和胆绞痛（52例患者中的17例，即33%）。一名患者进行多次手术的情况很常见。碎石术的费用通过两种方式计算：第一种是52名候选患者每人的个体费用；第二种是通过排除5名需要手术的患者以及5名预计碎石术失败的患者（10%）来计算成功碎石术的费用。包括术前评估、治疗、恢复室和随访，52例患者的个体碎石术费用为8275.00美元。如果在排除需要手术的患者和预计失败的患者后计算相同的总支出，每次“成功”的碎石术费用为10245美元。一年的胆汁酸治疗费用为1949.00美元或每次“成功”手术2413.00美元。随访费用为每名患者1232.00美元或每次“成功”手术1525.00美元。筛查最终非候选者所产生的额外碎石术费用为每次成功手术904.00美元。这些个体费用的总和为每次成功手术15087.00美元，而胆囊切除术的费用为3685.00美元。未考虑结石复发的费用。碎石术的成本似乎足够高，以至于该手术不太可能成为首选治疗方法。
