- 學位論文
良性子宮肌瘤患者進行腹式全子宮切除術之可能非臨床特徵探討
Non-clinical characteristics of patients who underwent total abdominal hysterectomy for benign leiomyoma
摘要
研究目的： 本研究探討良性子宮肌瘤患者進行腹式全子宮切除術之可能非臨床特徵。 研究方法： 本研究資料來源為2002 年至2009 年國家衛生研究院「承保抽樣歸人檔」 (LHID2005)之住院醫療費用清單明細檔(DD)。 研究對象納入條件為：1) 15 歲至50 歲婦女；2)ICD-9-CM 主診斷為良性子 宮肌瘤；3)執行子宮切除術。總樣本數為3,403 人，包含1,735 名執行腹式全子 宮切除術及1,668 名執行非腹式全子宮切除術。非腹式全子宮切除術包含了腹式 次子宮切除術、腹腔鏡輔助經陰道子宮切除術、經陰道子宮切除術。 本研究試分析個案之年齡、投保類別、投保金額、投保區域、醫院權屬別、 手術年度、共病症、過去子宮肌瘤切除經驗。 結果： 若雙變項分析及單變項邏輯斯迴歸中p≦0.2 即為進入多變項邏輯斯迴歸分 析之候選變項，多變項邏輯斯迴歸發現投保類別及投保所在區域有統計上的顯著 差異，然而，調整年齡、醫院權屬別、子宮肌瘤切除術經驗、手術年份之後，相 較於有固定雇主，職業工會有顯著執行較少腹式全子宮切除術 (OR=0.81,95%CI(0.69-0.95))及相較於固定雇主，農、漁、水利會有顯著執行較少腹式全子宮切除術(OR=0.73,95%CI(0.59-0.92))；相較於北部區域，中部區域有顯著執行較少腹式全子宮切除術(OR=0.68,95%CI(0.57-0.80))及相較於北部區域，南部區域有顯著執行較少腹式全子宮切除術(OR=0.78,95%CI(0.66-0.92))，而投保金額在調整了上述變項之後，依然沒有統計上的顯著差異。 結論： 在研究中發現，投保區域為北部以及有固定雇主者執行腹式全子宮切除術的 可能性較高，是否為全民健保給付制度或台灣私人保險相關，需要進一步研究來 證實。
並列摘要
Objectives: To investigate the non-clinical characteristics of patients who underwent total abdominal hysterectomy for benign uterine leiomyoma in Taiwan. Methods: We used Inpatient Expenditures by Admissions files of the Longitudinal Health Insurance Database from 2002 to 2009.The inclusion criteria were patients who: 1) was female aged between 15 and 50; 2) had primary ICD-9-CM diagnosis of benign uterine leiomyoma ; 3) underwent hysterectomy. The final sample available for the analyses was 3,403 (1,735 for total abdominal hysterectomy (TAH); 1,668 for non-TAH. Subtotal abdominal hysterectomy, laparoscopic assisted vaginal hysterectomy, and vaginal hysterectomy were categorized as non-TAH. Age, declared insurance wages, beneficiary category, hospital ownership, surgical year, major coexisting medical illnesses, registered location and myomectomy history were evaluated among final sample. Results : Candidate variables for inclusion in the model were those which had associations showing p≦0.2 either in bivariate analyses or univarate logistic regression. Multiple logistic regression analysis indicated that there were significant associations between patients’ beneficiary category, patients’ registered location and the likelihood of performing TAH. While adjusting for age, hospital ownership, surgical year,myomectomy history, the craft union of patients’ beneficiary category was associated with 20% lower odds of undergoing total abdominal hysterectomy for benign uterine leiomyoma compared to those persistent employers (odds ratio = 0.81, 95% confidence interval, 0.69-0.95). And the decreased odds ratio for farmers, fishermen and irrigation association was 0.73, 95% confidence interval,0.59-0.92. Adjusted odds ratios were also lower among patients who were registered in Central (odds ratio=0.68, 95% confidence interval, 0.57-0.80) and Southern (odds ratio = 0.78, 95% confidence interval, 0.66-0.92) Taiwan compared with Northern Taiwan. In addition,there were no significant effect for the likelihood of performing TAH between various declared insurance wages stratum in persistent employers. Conclusions: Our findings suggested that the likelihood of performing TAH for benign uterine leiomyoma was higher in patients registered in northern area and employed persistently.