Clinical Economics Study Of ERCP And Laparoscopy In The Treatment Of Common Bile Duct Stones

Objective:for common bile duct stones,nowadays there are two important minimally invasive treatment methods:one is the ERCP Lithotomy;the other is the Lap aroscopic Common Bile Duct Exploration.To the two methods of minimally invasive treatment for common bile duct stones,the efficacy,the safety and the economy has been the focus of people's attention.The purpose of this study is to explore the efficacy,the safety and the economy of ERCP Lithotomy and Laparoscopic Common Bile Duct Exploration in the treatment of common bile duct stones,and to provide an important reference for the selection of treatment methods for common bile duct stones to the vast of medical workers and patients Methods:In this paper,the clinical data from patients with common bile duct stones admitted in the First Affiliated Hospital of Fujian Medical University from 2015 January to 2016 December,screened by clinical cases with homogeneity(the difference of general information and clinical indicators was not statistically significant,P>0.05)treated by ERCP Lithotomy(ERCP Group)or Laparoscopic Common Bile Duct Exploration(Laparoscopic Group),was analyzed retrospectively.The differences of operation success,residual stones,intraoperative injury,postoperative complications,operation duration,related hospitalization time and related medical expenses between the two operative methods were compared and analyzed.And the method of the Cost-effectiveness Analysis(CEA)of Clinical Economics was taken to analyse and evaluate the two operative methods.Rerults:The ERCP Group and the Laparoscopic Group compared:in terms of the efficacy,with the success rate of ERCP Group and Laparoscopic Group(95.7% VS97.7%),the Laparoscopic Group was higher than that of ERCP group,but there was no statistically significant difference in the number of successful cases between the two groups(P>0.05);with the rate of residual stones(15.2% VS 4.7%),ERCP Group was higher than that of the Laparoscopic Group,but there was no statistically significant difference in the number of cases of residual stones bet ween the two groups(P>0.05).In terms of the security,with the incidence rate of the total postoperative complications of ERCP Group and Laparoscopic Group(32.6% VS 7%),the incidence rate of toperative biliary infection(19.6% VS 4.7%),the incidence rate of postoperative pancreatitis(19.6% VS 0%),ERCP Gro up was higher than that of Laparoscopic Group,and there were statistically significant differences in the number of cases between the two groups(P <0.05);with the incidence rate of the postoperative sepsis of ERCP Group and Laparoscopic Group(4.3% VS 0%),ERCP Group is higher than that of Laparoscopic Group,but there was no statistically significant difference in the number of cases of the postoperative sepsis between the two groups(P>0.05);the incidence rate of the postoperative bile leakage of ERCP Group and Laparoscopic Group(0% VS2.3%),the Laparoscopic Group was higher than that of ERCP Group,but there was no statistically significant difference in the number of cases of the posto perative bile leakages between the two groups(P>0.05).in terms of the economic,the total cost of ERCP Group and the total cost of Laparoscopic Group(32701.8±8828.51 VS 33730.1±9604.50)yuan,the examination fee(2415.7±1094.99 VS 2131.23±1588.22)yuan,the test fee(1679.53±778.41 VS 1838.50±962.36)yuan,the differences were not statistically significant(P>0.05);the operation fee(2977.17±984 VS 6444.88±1080.26)yuan,the treatment cost(1520.61±623.44 VS 2886.20±872.17)yuan,the cost of Western Medicine(9149.55±5948.65 VS 11897.63 ±6218.32)yuan,the nursing fee(586.24±343.49 VS 890.07±369.27)yuan,the hygienic material fee(13677.38±3278.81 VS 5748.16±174 5.95)yuan,the differences were statistically significant(P<0.05);the total hospitalization time(10.76±4.82 VS 13.70±4.30)d,the hospitalization time before operation(5.61±3.26 VS 7.51±3.78)d,the operation duration(62.22±30.30 VS 88.81±39.85)min,the average total hospitalization time,the hospitalization time before operation and the average operation durati on in Laparoscopic Group were longer than those in ERCP Group,and the differences were statistically significant(P<0.05);the postoperative hospitalization time(5.15±3.16 VS 6.19±2.04)d,the average postoperative hospitalization time in La paroscopic Group was longer than that in ERCP Group,but the difference was not statistically significant(P>0.05);the Cost-effectiveness Ratio(Cost/Effectiveness,C/E)of ERCP Group was 34171.25,and C/E of Laparoscopic Group was 34524.25,and the Incremental Cost-effectiveness Ratio(ICER)of the two groups was 17650.Conclusion:There was no difference in curative effect between ERCP Lithotomy and Laparoscopic Common Bile Duct Exploration in the treatment of common bileduct stones,but the safety of Laparoscopic Common Bile Duct Exploration in the treatment of common bile duct stones is superior to ERCP Lithotomy and the economy of ERCP Lithotomy in the treatment of common bile duct stones is superior to Laparoscopic Common Bile Duct Exploration.Medical workers should be based on the specific conditions of patients with common bile duct stones,combined with their own conditions and technology,to choose a reasonable treatment plan to achieve the best therapeutic effect.