Van Stiegmann G, Pearlman N W, Goff J S, Sun J H, Norton L W
Department of Surgery (Gastrointestinal/Tumor), University of Colorado, Denver.
Arch Surg. 1989 Jul;124(7):787-9; discussion 789-90. doi: 10.1001/archsurg.1989.01410070037008.
Would economic benefit result from performing endoscopic cholangiography and removal of common bile duct stones prior to cholecystectomy in patients who are suspected preoperatively of having choledocholithiasis? In this study, 173 patients had cholecystectomy and 30 (17%) had common bile duct exploration. Records of these patients were reviewed as were those of 31 patients who had only endoscopic cholangiography and endoscopic stone removal. Cost estimates were based on local charges. Cholecystectomy with common bile duct exploration was $6730 more per patient than cholecystectomy alone. Endoscopic cholangiography and endoscopic stone removal was 87% successful in removing duct stones. Had endoscopic cholangiography and endoscopic stone removal been performed preoperatively in patients undergoing cholecystectomy who had suspected choledocholithiasis, 21 of 30 common bile duct explorations could theoretically have been eliminated. This would have saved $85,526 or $2851 per patient undergoing common bile duct exploration. Our analysis suggests that patients who require cholecystectomy and have suspected choledocholithiasis may be treated more cost-effectively by performing endoscopic cholangiography and endoscopic stone removal immediately prior to cholecystectomy than by cholecystectomy and operative common bile duct exploration.
对于术前怀疑患有胆总管结石的患者，在胆囊切除术之前进行内镜胆管造影和胆总管结石取出术是否会产生经济效益？在本研究中，173例患者接受了胆囊切除术，其中30例（17%）进行了胆总管探查。回顾了这些患者的记录以及31例仅接受内镜胆管造影和内镜下取石的患者的记录。成本估计基于当地收费标准。胆囊切除术联合胆总管探查比单纯胆囊切除术每位患者多花费6730美元。内镜胆管造影和内镜下取石术在取出胆管结石方面成功率为87%。对于术前怀疑患有胆总管结石且接受胆囊切除术的患者，如果术前进行内镜胆管造影和内镜下取石术，理论上30例胆总管探查中有21例可以避免。这将节省85526美元，即每位接受胆总管探查的患者节省2851美元。我们的分析表明，对于需要进行胆囊切除术且怀疑患有胆总管结石的患者，在胆囊切除术之前立即进行内镜胆管造影和内镜下取石术可能比胆囊切除术和手术胆总管探查更具成本效益。
