胃繞道減重手術對於病態性肥胖病人之效益評估

The Effects of Roux-en Y Gastric Bypass on Morbidly Obese Patients and Medical Efficiency

陳文旭(Wen-Hsu Chen)

指導教授 ： 邱亨嘉

高雄醫學大學/健康科學院/醫務管理學研究所碩士在職專班/碩士(2008年)

摘要

背景：全世界肥胖的盛行率有急速上昇的趨勢，不管是已開發國家或發展中的國家，過重或肥胖人口的比例和成長，都以破紀錄的速度上升。根據統計，肥胖會導致許多疾病並影響治療，特別是病態性肥胖即身體質量指數BMI＞40kg/m2的病人，其死亡率會呈現一個急遽增加的曲線，唯有快速而且有效的降低體重才可能扭轉此一曲線。減重手術是病態性肥胖且合併有肥胖相關疾病者最有效且持久的減重治療方法，外科治療的目的是透過巨量減重來改善病態性肥胖者的健康狀態以增進壽命，外科減重手術中又以胃繞道手術(Roux-en-Y Gastric Bypass)效果最好，而以腹腔鏡手術施行又最為病患所接受。
研究方法：本研究對象乃自2005年8月1日起至2008年2月29日止，在高雄縣某區域教學醫院施行腹腔鏡胃繞道減重手術之病態性肥胖患者，研究採立意取樣且以病歷檢閱之回溯性方式蒐集研究資料。研究回收資料以SPSS for Windows 12.0統計套裝軟體作為分析的工具，驗證本研究假設採用統計方法有描述性統計分析、獨立樣本t檢定、單因子變異數分析、相關分析及線性複迴歸分析。
研究結果：隨著時間的演進與醫師開刀成熟度的增長，病患在進行胃繞道減重手術後平均住院日會有顯著性地縮短，當次總醫療費用、後續追蹤醫療總費用則有顯著性增加。針對研究對象的高血壓、高血脂、高血糖、肝指數、高尿酸等數值正常與否進行手術前後測比較發現，接受胃繞道減重手術後，身體健康狀態有非常明顯的改善；此外，進行胃繞道減重手術後之BMI值有持續性的下降趨勢，表示胃繞道減重手術在體重減輕上有其卓越效果。
結論：除醫師必須不斷提昇自我的手術成熟度外，整個醫療團隊的成熟度亦不斷提昇，甚至發現手術成熟度會影響到病患術後的整體復原情況。在醫療總費用方面，隨著醫師手術成熟度增長、技術面越來越成熟，與醫療材料的進步，醫療費用有上升的趨勢，此乃因醫師自認技術純熟故提高手術技術費所致；但就整體而言，進行胃繞道減重手術後，病患的健康狀態卓越提升，慢性疾病有顯著改善情況，可整體提升病患之生活品質與降低後續醫療費用支出，進而降低醫療資源之耗用情形。

關鍵字

病態性肥胖 ； 胃繞道減重手術 ； 醫療效益

並列摘要

Objective：Obesity has been on the rise worldwide and the number of overweight/obese people is growing at an unprecedented rate in both developed and developing nations. Statistics show that obesity not only leads to numerous diseases but also interferes with disease treatments. Especially for patients with a body mass index (BMI) of over 40kg/m2, also known as morbidly obese patients, the mortality rate undergoes such an exponential growth that only by losing weight rapidly and efficiently may the growth of death rate be slowed down. Currently, weight loss surgeries lead to the most impressive and long-lasting results as a weight loss treatment for morbid obesity and obesity related diseases. Such surgical treatment aims to improve the health and thus extend the lifespan of morbidly obese patients via massive weight reduction. Among massive weight reduction surgeries, Roux-en Y Gastric Bypass proves most effective, with laparoscopy as the most favored technique among patients.
Methods：The subjects of this study were morbidly obese patients who underwent Roux-en Y Gastric Bypass at a teaching hospital in Kaohsiung County, Taiwan ROC between August 1, 2005 and February 29, 2008. Purposive sampling and retrospective medical record review were employed during data collection. To test the hypothesis, descriptive statistical analysis, independent t-test, one-way ANOVA, correlation analysis, and multiple regression analysis were performed on SPSS for Windows 12.0.
Results：With time and the development of surgeons’ experience, subjects who underwent Roux-en Y Gastric Bypass had significantly shortened their average stay at the hospital after the surgery while total medical expenses for the surgery and further follow-ups had increased significantly. The pre- and post-surgical comparison on the levels of hypertension, hyperlipidemia, hyperglycemia, liver enzymes (GOT/GPT), and hyperuricemia found that subjects had significantly improved in these figures, and thus their health, after Roux-en Y Gastric Bypass. In addition, a persistent downward trend in the subjects’ BMI values had resulted to prove the outstanding effect of this surgical treatment.
Conclusions：On the whole, the development in experience for both the surgeons and the medical team has an impact on the overall recovery of morbidly obese patients who undergo Roux-en Y Gastric Bypass. In terms of total medical expenses, an upward trend has been observed due to the cost incurred by surgeons’ improved expertise, the development of surgical techniques, and the advancement in medical supply and facility. To conclude, Roux-en Y Gastric Bypass has a significant effect on improving the patients’ health and alleviating chronic diseases. After the treatment, patients experience better life quality with lower future medical expenses, thereby reducing the exhaustion of medical resources.

並列關鍵字

Morbid obesity ； Roux-en Y Gastric Bypass ； Medical efficiency

參考文獻

英文文獻

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