Jorba Martín Rosa, Ramirez Maldonado Elena, Fabregat Prous Joan, Buisac González Dolors, Banqué Navarro Marta, Gornals Soler Joan, Busquets Barenys Juli, Ramos Rubio Emilio, Peláez Serra Núria, Lladó Garriga Laura, Rafecas Renau Antoni
Servicio de Cirugía General y Aparato Digestivo, Consorci Sanitari Integral, L'Hospitalet del Llobregat, Barcelona, España.
Cir Esp. 2012 May;90(5):310-7. doi: 10.1016/j.ciresp.2012.02.003. Epub 2012 Apr 4.
The treatment of bile duct calculi associated with cholelithiasis is controversial. The hospital costs could be a decisive factor in choosing between the different therapeutic options.
To compare the effectiveness and costs of two options in the treatment of common bile duct calculi: 1) One-stage: Laparoscopic cholecystectomy and bile duct exploration, and 2) Two-stage: sequential endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy.
A retrospective, observational study was performed on 49 consecutive patients with bile duct calculi and gallbladder in situ, treated consecutively and simultaneously over a two year period. The post-operate complication, hospital stay, number of procedures per patient, conversion to laparotomy, efficacy of removing the calculi, and hospital costs.
There were no differences as regards the patient clinical features or morbidity. The mean post-surgical hospital stay for the One-stage group was less than that in the Two-stage group. Three patients of the Two-stage group required conversion to laparotomy. The median costs per patient were less for the One-stage strategy, representing an overall saving of 37,173€ during the period studied.
No significant differences were found between the two treatment options as regards efficacy or post-surgical morbidity and mortality, but there were differences in hospital stay and costs. The management of patients with gallstones in one-stage surgery represents a saving of 3 days hospital stay and 1,008€ per patient.
胆囊结石合并胆管结石的治疗存在争议。在选择不同的治疗方案时，医院费用可能是一个决定性因素。
比较两种治疗胆总管结石方案的有效性和成本：1）一期手术：腹腔镜胆囊切除术和胆管探查术；2）二期手术：序贯性内镜逆行胰胆管造影术和腹腔镜胆囊切除术。
对连续两年内连续收治的49例胆管结石合并原位胆囊患者进行回顾性观察研究。观察术后并发症、住院时间、每位患者的手术次数、中转开腹情况、结石清除效果及住院费用。
患者的临床特征和发病率无差异。一期手术组术后平均住院时间短于二期手术组。二期手术组有3例患者需要中转开腹。一期手术策略每位患者的中位费用更低，在所研究期间总体节省了37173欧元。
两种治疗方案在疗效、术后发病率和死亡率方面无显著差异，但在住院时间和费用方面存在差异。一期手术治疗胆结石患者可节省3天的住院时间，每位患者节省1008欧元。
