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  • 學位論文

台灣子宮外孕手術治療方式之趨勢-2001至2010年

Trends in the surgery type for ectopic pregnancies in Taiwan, 2001-2010

指導教授 : 林文德

摘要


目的:本研究的目在於利用健保局2001-2010年共10年間資料,來描述分析台灣地區子宮外孕手術治療的年代趨勢變化,及因病人年齡、醫院的層級、治療醫師的年齡或性別、治療醫院的都市化程度,所造成的手術方式的變化傾向。 方法:本研究採回溯性世代研究,以健保8%樣本,統計分析2001-2010年台灣地區健保納保婦女因子宮外孕,執行剖腹探查手術治療,或是腹腔鏡手術治療的資料。並統計分析疾病診斷代碼、費用支付代碼、治療手術代碼,以及被保險人和醫院及醫師的各種特性的相關性。 結果:本研究共統計2001-2010年台灣地區間共40,458例子宮外孕手術的病例,其中剖腹探查手術共11,975例,腹腔鏡手術共28,483 例。子宮外孕手術的年度發生數隨著年代有下降的趨勢,但腹腔鏡手術的比例從2001年的61.2%上升到2010年的82.5%,經Cochran-Armitage 趨勢檢定顯示上升趨勢顯著(P < 0.01),其中,25歲以下年輕的病人,手術治療的醫院為醫學中心,手術醫師年紀小於40歲,手術醫師為女性醫師,高度都市化地區的醫院,腹腔鏡手術的比例有明顯上升的情形。 結論:以2001-2010年台灣地區的健保資料統計分析,腹腔鏡手術治療子宮外孕的比率明顯增加,而病人年齡、醫院等級、手術醫師的年齡和性別、醫院的都市化程度,都會顯著影響子宮外孕手術治療的方式。

並列摘要


Objective This study examined trends of the surgeries for ectopic pregnancies in Taiwan from 2001 to 2010. Methods With a retrospective cohort study design, we used 8% Taiwan’s Longitudinal Health Insurance Dataset in 2001-2010 which consisted of 2 million of representative sample of National Health Insurance beneficiaries to identify women who underwent surgeries for ectopic pregnancies in Taiwan. Cochran-Armitage Trend Test was performed to test the significance of trend’s change. . Logistic regression was applied to explore the association between the probability of undergoing laparoscopy with patients’ age , hospital level ,surgeon’s age and gender , hospital townships, and the degree of urbanization. Results This study identified 40,458 ectopic pregnancy operations, including 11,975 laparotomy and 28,483 laparoscopy .The annual number of ectopic pregnancy operations decreased from 2001to 2010. Laparoscopy significantly increased from 61.2% in 2001 to 82.5% in 2010( P <0.01). Laparoscopy was significantly performed more in younger patients, patients treated in medical centers or area with higher urbanization , patients attended by female or younger surgeon. Conclusions We found significantly increasing trends in the surgeries for ectopic pregnancy in Taiwan over 2001-2010. Patients’ age, hospital level, surgeon’s age and gender, and level of urbanization of the hospital all attributed to the likelihood of receiving laparoscopy in patients with ectopic pregnancy.

並列關鍵字

ectopic pregnancy laparoscopy laparotomy

參考文獻


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