Clinical And Health Economic Evaluation Of Intraoperative Cholangiography With Laparoscopic Ultrasound Using In Commun Bile Duct Stone Exploration

[Purpose]1 .To evaluate the value of laparoscopic ultrasound ( LUS ) and intraoperative cholangiography (IOC) in common bile duct exploration by comparing the results and feasibility of IOC and LUS.2. To analysis the cost/benefit of laparoscopic ultrasound ( LUS ) and intraoperative cholangiography (IOC).[Setting]Department of General Surgery, RuiJin Hospital and ShiZheng Hospital, Shanghai Second Medical University. [Method]100 patients with LC and CBD exploration indication had been included this clinical diagnostic test during June of 2000 to September of 2001.All patients were examined LUS and LOG before cholecystectomy, The successful rate and examining time was recorded in order to result the sensitivity, specificity, positive predictive value, negative predictive value LUS, LOG, and LUS combining with LOG respectively. We evaluated 3 diagnostic methods with cost-effect analysis and calculated the cost/benefit with incremental analysis bycomparing LUS and LOG combining LUS. Also we calculated the cost and benefit of each additional diagnosis of CBD stone by LUS+IOC[Measurement and Result]Success rate LOG 94.9%, LUS % 100%0 Operative time LOC= 11.37+ 3.53min, LUS=7.68+2.14mino There are no significant difference between 2 groups (P<0.01).LOG sensitivity 85.0%, specificity 96.2%, accuracy 91.4%,Positive predictive value:94.4%, Negative predictive value: 89.5%, Positive likelihood ratio:22.4; Negative likelihood ratio: 0.156; LUS sensitivity 82.5%, specificity 98.1%, accuracy 91.4%, Positive predictive value:97.1% , Negative predictive value:88.1%, Positive likelihood ratio: 43.4, Negative likelihood ratio: 0.178; LUS+LOC sensitivity: 97.5%, specificity: 94.3%, accuracy: 95.7%, Positive predictive value:92.9%, Negative predictive value:98.0%, Positive likelihood ratio: 17.1, Negative predictive value:0.027,IOC, LUS and LUS+LOC cost/effectiness is 601.76RMB, 845.45RMB and 963.08RMB respectively. Comparing with IOC alone, each additional diagnosis of CBD stone by LUS+IOC will increase the cost of 3420RMB but gain the benefit of 5545.5RMB, and pure benefit was 10627.5RMB.[Conclusion]LUS can increase the accuracy of diagnosing CBD stone for whom can not be diagnosed by IOC. The cost/effect and cost/benefit show that IOC combining with LUS is not only a clinical valuable method but also an economic way in diagnosing CBD stone.