Go P M, Stolk M F, Obertop H, Dirksen C, van der Elst D H, Ament A, van Erpecum K J, van Berge Henegouwen G P, Gouma D J
Department of Surgery, University Hospital Maastricht, The Netherlands.
Surg Endosc. 1995 Jan;9(1):37-41. doi: 10.1007/BF00187882.
In order to strike the most favorable balance between health benefits and costs, three treatment modalities for symptomatic cholelithiasis were compared in a cost-effectiveness study: extracorporeal shock-wave lithotripsy (ESWL), conventional cholecystectomy (CC), and laparoscopic cholecystectomy (LC). Data were analyzed from 55 patients who were treated by ESWL, 45 patients who had CC, and 47 patients who had LC. The study was performed by analysis of patients charts and a written questionnaire. After ESWL 35% of the patients were free of stones, 23% had fragments < or = 5 mm, and 42% had fragments > 5 mm at 1-year follow-up. Persistent complaints were reported by 59% after ESWL, 11% after CC, and 14% after LC (P < 0.001). New complaints arose in 12% after ESWL, 11% after CC, and in 5% after LC (P = NS). Patient appreciation score was highest for LC and lowest for ESWL. Mean hospital stay was 2.4 days for ESWL, 10 days for CC, and 3.5 days for LC. Overall costs of treatment were: $5,066 for ESWL; $5,893 for CC; and $3,117 for LC. This study reveals that laparoscopic cholecystectomy is the most effective treatment of the large majority of patients with symptomatic cholelithiasis. ESWL should only be considered in the case of a solitary, relatively small, completely radiolucent stone.
为了在健康效益和成本之间达成最有利的平衡，在一项成本效益研究中对有症状胆结石的三种治疗方式进行了比较：体外冲击波碎石术（ESWL）、传统胆囊切除术（CC）和腹腔镜胆囊切除术（LC）。分析了55例接受ESWL治疗的患者、45例接受CC治疗的患者和47例接受LC治疗的患者的数据。该研究通过分析患者病历和书面问卷进行。ESWL治疗后1年随访时，35%的患者结石消失，23%的患者结石碎片≤5mm，42%的患者结石碎片>5mm。ESWL治疗后59%的患者有持续不适主诉，CC治疗后为11%，LC治疗后为14%（P<0.001）。ESWL治疗后12%的患者出现新的不适主诉，CC治疗后为11%，LC治疗后为5%（P=无显著性差异）。患者满意度评分LC最高，ESWL最低。ESWL的平均住院时间为2.4天，CC为10天，LC为3.5天。总体治疗费用为：ESWL为5066美元；CC为5893美元；LC为3117美元。这项研究表明，腹腔镜胆囊切除术是大多数有症状胆结石患者最有效的治疗方法。ESWL仅在孤立、相对较小、完全透X线结石的情况下才应考虑。
