Ho H S, Mathiesen K A, Wolfe B M
Department of Surgery, Davis Medical Center, University of California, 4301 X Street, Sacramento, CA 95817-2214, USA.
Surg Endosc. 1996 Jul;10(7):746-50. doi: 10.1007/BF00193049.
There has been a debate about the cost-effectiveness of laparoscopic cholecystectomy (LC), as well as a concern regarding its possible overutilization and changes in the indication for surgery.
A retrospective analysis of all cholecystectomies performed at UCDMC from 1988 to 1994 was done. The annual rate of cholecystectomy increased by 50% in 1990 when LC was introduced but has since stabilized at a rate 11% higher than the rate before LC. The disease status and severity did not change.
The incidence of nonelective surgery remained stable at 31.2% to 37.5%. Elective cholecystectomy had lower mortality (0.16% vs 1.8%, P = 0. 029), morbidity (2.6% vs 11.2%, P = 0.0001), and conversion rate (2. 6% vs 16%, P = 0.0001) and a shorter length of stay (2.1 days vs 5.4 days), compared with nonelective procedure.
The indication for surgery in cholelithiasis has not changed since the introduction of LC. In patients with symptomatic gallstones, early elective surgery is recommended and may be more cost-effective.
关于腹腔镜胆囊切除术（LC）的成本效益存在争议，同时也有人担心其可能存在过度使用以及手术指征的变化。
对1988年至1994年在加州大学戴维斯分校医疗中心（UCDMC）进行的所有胆囊切除术进行回顾性分析。1990年引入LC时，胆囊切除术的年增长率提高了50%，但此后稳定在比引入LC前高11%的水平。疾病状态和严重程度没有变化。
非选择性手术的发生率保持稳定，为31.2%至37.5%。与非选择性手术相比，选择性胆囊切除术的死亡率更低（0.16%对1.8%，P = 0.029）、发病率更低（2.6%对11.2%，P = 0.0001）、转化率更低（2.6%对16%，P = 0.0001）且住院时间更短（2.1天对5.4天）。
自引入LC以来，胆石症的手术指征没有变化。对于有症状的胆结石患者，建议早期进行选择性手术，这可能更具成本效益。
