• 作者：Rosa Jorba Martí ; n^a ; ^{24271rjm@comb.cat} ; Elena Ramirez Maldonado^b ; Joan Fabregat Prous^b ; Dolors Buisac Gonzá ; lez^c ; Marta Banqué ; Navarro^d ; Joan Gornals Soler^e ; Juli Busquets Barenys^b ; Emilio Ramos Rubio^b ; Nú ; ria Pelá ; ez Serra^b ; Laura Lladó ; Garriga^b ; Antoni Rafecas Renau^b
• 关键词：Litiasis de la ví ; a biliar principal ; Coledocolitiasis ; Coledocotomí ; a laparoscó ; pica ; Exploració ; n transcí ; stica ; Colangiopancreatografí ; a retró ; grada endoscó ; pica asociada a esfinterotomí ; a ; Coste ef
• 刊名：Cirug篓陋a Espa?ola
• 出版年：2012
• 期刊代码：pca87_0009739X
• 类别：med
• 出版时间：May, 2012
• 卷：90
• 期：5
• 页码：310-317
• 文件大小：355 K

Introduction

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.

Objectives

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.

Material and methods

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.

Results

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鈧?during the period studied.

Conclusions

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鈧?per patient.