探討大腸直腸癌手術切除病人發生率與醫療資源耗用分佈趨勢及影響因素

研究目的大腸直腸癌躍居台灣地區國民罹癌榜首，發生率與醫療資源耗用逐年增高，因此本研究目的為探討大腸直腸癌手術切除病人發生率與醫療資源耗用(住院天數以及住院總費用)之分佈趨勢及影響因素。研究方法本研究採用回溯性資料分析，收集民國93年4月至98年12月在南台灣某區域醫院之所有大腸直腸癌手術切除病患，研究樣本共778人。資料來源是前來本院就診的受檢者病歷，所收集之內容包括受檢者的基本資料(人口學變項與疾病特質)，研究結果則包含發生率與醫療資源耗用(住院天數與住院總醫療費用)。研究方法利用Odds Ratio(勝算比)、Effect Size(改善幅度)、邏輯式與直線複迴歸模式，探討大腸直腸癌手術切除病人發生率與醫療資源耗用之分佈趨勢及影響因素。研究結果本研究發現93年每十萬人口大腸直腸癌病患發生率為12.21人，98年增加至17.89人，年齡層以71-80歲的28.15%、61-70歲28.2%、51-60歲24.04%比率為最多。病患來源經由急、門診發現比率高達96.02%。腫瘤位置以乙狀結腸35.73%及直腸30.46%為最多。腫瘤分期以第二期37.28%、第三期34.19%為最多。腫瘤病理分化中等為82.01%。住院醫療費用平均為128543元，住院天數平均為15.4天。住院天數與住院費用有下降趨勢。年齡≦60歲、女性及經由健診者，發生率有上升的趨勢(健診在97-98年為93-94年的1.77倍)。以臨床發現施行高位切除或腹部會陰切除及腫瘤病理分化中等者有增加的趨勢。腫瘤位置在乙狀結腸、腫瘤分期為第一期發生率顯著提高(p<0.05)。年齡61~70歲、手術方式為低位切除或超低位切除、腫瘤病理分化良好、有轉移部位、腫瘤位置為直腸發生率顯著下降(p<0.05)。年齡越大，經急、門診發現，施行腹部會陰切除、腫瘤越大、腫瘤病理分化中等，腫瘤位置為橫結腸或乙狀結腸、腫瘤分期為第四期會顯著增加住院天數(p<0.05)。以內視鏡腫瘤切除者住院天數明顯降低。控制時間因素，男性、年齡、病患來源為急、門診單位、手術方式為高位切除、右側切除、左側切除或超低位切除、腫瘤數目、腫瘤大小、淋巴結侵犯、腫瘤病理分化中等或不良、有轉移部位、有化療者、腫瘤位置為橫結腸、降結腸、乙狀結腸或直腸、腫瘤分期為第二或第四期會顯著增加住院費用(p<0.05)。結論大腸直腸癌手術切除病人發生率有增加趨勢，門急診病人其醫療資源耗用顯著較健診病人為高，鼓勵民眾應定期接受大腸直腸鏡檢，早期發現，早期接受治療。研究發現可以推廣至台灣其他醫院，以提供醫護人員以及大腸直腸癌手術切除病人與家屬，於臨床預後照護參考。

關鍵字

大腸直腸癌手術切除病人；發生率；分佈趨勢；住院天數；住院費用

並列摘要

In Taiwan, colorectal cancer is the most common cancer people get, and its occurrence rate and medical cost are increasing every year. The purpose of this study was to analyze the distribution tendency and affecting factors of the occurrence rate and the consumption of medical resourses among colorectal cancer patients who needed to receive resection. The subjects were 778 patients who had resection of colorectal cancer in a regional hospital in southern Taiwan from April 2004 to December 2009. The study results indicated the occurrence rate and the medical cost. The statistic research methods were Odds Ratio, Effect Size, Logistic and Multiple Regression Model. The study found that occurrence rate of the colorectal cancer was12.21 people per one hundred thousand in population in 2004. In2009, it went up to 17.89. The age ranges with the highest ratios were 71-80 at 28.15% , 61-70 at 28.2%, and 51-60 at24.04%. The tumor was mostly found in sigmoid colon and rectum with a percentage of 35.73% and 30.46% respectively, and 37.28 % in its stage II and 34.19% stage III. The length and cost of hospitalization had a tendency of decreasing . The rate to find the disease in people under 60 years old, women and the health examination department tended to increase. For example, The ratio of it being found in health examination department was 5.79 times greater in 2008-2009 than in 2004-2005. Patients going through High The occurrence ratios of tumor in TNM stage I were increasing significantly (P<0.05). The length of hospitalization was decreasing yearly, but increased sharply if the patient was older, from OPD or ER, once had Abdominal Perineal Resection,with a bigger tumor whose histopathological grading was moderate differentiated, with tumor in transverse colon or sigmoid colon and TNM in stageIV (P<0.05). The hospitalization cost went up obviously if the patient was male, from ER, OPD, with more and bigger tumors, Lymph Node invasion, histopathological grading with moderate or poor differentiation , with metastasis, was going through chemotherapy and TNM in the second or fourth stage. Patients with colorectal cancer having to undergo resection are increasing. The medical cost is much higher in ER, OPD than in health examination department. People should have regular colonscopic examination in order to have early diagnosis and early treatment , The finding of this study can be the references for medical staff, patients and their family to provide screening colonoscopy and care after the resection procedure.

並列關鍵字

patients having accepted colorectal cancer resection ； , occurrence rate ； distribution tendency ； the length of hospitalization ； hospitalization cost