经内镜逆行胰胆管造影与开腹手术治疗胆总管结石及其合并胆囊良性病变的成本-效果分析

Cost-effectiveness Analysis of Endoscopic Retrograde Cholangio-pancreatography and Surgery in the Treatment of Common Bile Duct Stone or Combined with Gallbladder Benign Lesions

目的比较经内镜逆行胰胆管造影与开腹手术治疗单纯胆总管结石及胆总管结石合并胆囊良性病变的成本-效果。方法对2009年1月-2012年12月596例接受ERCP治疗(ERCP组)及173例接受开腹胆总管切开取石术(手术取石组)的单纯胆总管结石患者的临床资料进行回顾性分析,比较两组患者的治愈率、术后并发症发生率、住院时间、术前准备时间及住院总费用。对同一时期29例接受ERCP+腹腔镜胆囊切除(LC)术治疗(ERCP+LC组),38例接受单纯腹腔镜治疗(腹腔镜组)及129例接受开腹胆总管切开取石术+胆囊切除术(手术取石+切除组)的胆总管结石合并胆囊良性病变患者的临床资料进行回顾性分析,比较指标同上。结果单纯胆总管结石患者中,ERCP组与手术取石组的治愈率及术后并发症发生率比较,差异无统计学意义(P>0.05);但住院总费用[(1.31±0.63)万元、(2.06±0.75)万元]、住院时间[(8.91±4.95)、(12.14±5.15)d]及术前准备时间[(3.77±3.09)、(5.13±3.99)d]比较,差异有统计学意义(P<0.05)。胆总管结石合并胆囊良性病变患者中,3组间治愈率及术后并发症发生率比较,差异无统计学意义(P>0.05)。ERCP+LC组与手术取石+切除组住院总费用[(1.89±0.46)万元、(2.32±0.89)万元]、住院时间[(9.00±3.74)、(12.47±4.50)d]及术前准备时间[(3.24±1.83)、(5.15±2.98)d]比较,差异有统计学意义(P<0.05)。ERCP+LC组与腹腔镜组比较,住院总费用与住院时间差异均无统计学意义(P>0.05);但前者术前准备时间明显短于后者,差异有统计学意义(P<0.05)。结论对于单纯胆总管结石的治疗,ERCP具有费用少、住院时间及术前准备时间短且与外科手术等效的优点;对于胆总管结石合并胆囊良性疾病的治疗,ERCP+LC术相比传统外科开腹手术,也具有同样的优势。

Objective To compare the cost-effectiveness between endoscopic retrograde cholangio-pancreatography（ERCP） treatment and laparotomy treatment for simple common bile duct stone or common bile duct stone combined with gallbladder benign lesions. Methods A total of 596 patients with common bile stone received ERCP（ERCP group） and 173 received open choledocholithotomy（surgical group） in our hospital between January 2009 and December 2012. Their clinical data were retrospectively analyzed. The curing rate, postoperative complications, hospital stay, preoperational preparation and total cost were compared between the two groups of patients. Meanwhile, for common bile stone combined with gallbladder benign lesion, 29 patients received ERCP combined with laparoscopic cholecystectomy（LC）（ERCP＋LC group）, 38 received pure laparoscopy treatment（laparoscopy group） and 129 received open choledocholithotomy combined with cholecystectomy（surgery group）. Results For simple common bile stone patients, no significant difference was found in cure rate and post-operative complication between endoscopic and surgical treatment groups（P〉 0.05）. However, total hospitalization expenses [（13.1 ± 6.3） thousand yuan,（20.6 ± 7.5） thousand yuan）], hospital stay [（8.91 ± 4.95）,（12.14 ± 5.15） days] and preoperative preparation time [（3.77 ± 3.09）,（5.13 ± 3.99） days] were significantly different between the two groups（P〈 0.05）. For patients with common bile stone combined with gallbladder benign lesion, no signifi cant discrepancy was detected among the three groups in curing rate and post-operative complications（P 〉0.05）. Signifi cant differences were detected between ERCP＋LC group and surgical group in terms of total hospitalization expense [（18.9 ± 4.6） thousand yuan,（23.2 ± 8.9） thousand yuan] hospital stay [（9.00 ± 3.74）,（12.47 ± 4.50） days] and preoperative preparation time [（3.24 ± 1.83）,（5.15 ± 2.98） days]. No signifi cant difference was found in total hospitalization expense and hospital stay, while signifi cant difference was detected in preoperative preparation time between ERCP＋LC group and simple LC group. Conclusions For patients with simple common bile stone, ERCP is equivalent to surgery in the curing rate, and has more advantages such as less cost, shorter length of hospital stay, and lower preoperative preparation time. For the treatment of common bile duct stone with gallbladder benign disease, ERCP combined with LC also has more advantages than traditional surgery.