- 學位論文
以病例對照研究法分析闌尾炎與大腸癌之相關性
A case-control study on the association between appendicitis and colon cancer
摘要
背景：由於大腸癌的高發生率、盛行率與死亡率，因此，研究者們無不積極試圖研究大腸癌的危險因子與相關疾病。除了經常被研究且反覆確認的癌症風險因子外，許多學者仍致力於尋找其他可能的致病因子，尤其是在短期內就具高度影響性的前驅危險因子。在論文回顧的過程中，令人印象深刻的便是急性闌尾炎與闌尾切除。 目的：在論文回顧的過程中，令人印象深刻的便是急性闌尾炎似乎與大腸癌高度相關。於是我們試圖更進一步地分析台灣族群中急性闌尾炎與與大腸癌的關聯性，希望能夠提供臨床上適當的建議。 研究方法：本研究的資料來源是台灣全民健康保險研究資料庫(2006-2008)，使用的方法是回溯性重疊式病例對照分析法（nest case control analysis），並且使用卡方檢定和條件式邏輯迴歸，來調查大腸癌和先前曾經罹患闌尾炎之間的關聯性。 研究結果：本研究的結果顯示，藉由條件式邏輯迴歸分析可知，在調整過病患的月收入、居住區域和都市化程度後，罹患大腸癌的病患先前曾出現急性闌尾炎的可能性較高（勝算比為3.447，P < 0.0001）。研究也顯示，相較於無收入組，收入高於平均薪資的人，罹患大腸癌的機率高出1.399倍（P < 0.0009）。比起居住在北台灣的人，居住在中台灣和南台灣的人，其罹患大腸癌的可能性分別低了0.619倍和0.676倍（P < 0.0001）。 結論：本研究發現罹患大腸癌的病患先前曾出現急性闌尾炎的可能性較高。因此，我們建議，年紀超過40歲以上之急性闌尾炎病患，術前應詳細問診並接受斷層掃瞄檢查，高危險病患應考慮下正中剖腹探查，並於術後六週接受全大腸纖維鏡檢以排除大腸癌的可能性。後須追蹤部分，應將全大腸鏡檢頻率提高，希望能早期偵測大腸癌並早期治療。
並列摘要
Introduction: The risk factors of colorectal cancer have been of great interests among researchers who aimed to prevent the development of colorectal cancer and to provide efficient early screening. Except those well-known risk factors, We’ve tried to search another possible factors from the literature review. Subject: Some previous studies have indicated a correlation between appendicitis and colon cancer. So we try to analysis the possible corelation between then from Taiwanese population. Method: Our empirical analysis used a huge dataset, sourced from the NHIRD of Taiwan, covering from year 2006 to 2008. A retrospective nested case-control analysis was utilized, along with Chi-squared tests and conditional logistic regression in order to examine associations between colon cancer and previously diagnosed appendicitis. Result: There were39 (0.27%) and 59 (0.41%) individuals found with previously diagnosed appendicitis in the case and control group, respectively (P<0.001). Furthermore, conditional logistic regression analysis (conditional on sex, age, and index year) revealed that the odds of previous diagnosed appendicitis were 3.3350 (P < 0.001) times more prevalent in the case group than the controls. When comparing to the control group, conditional logistic regression analysis indicated that patients with colon cancer were more likely to have had previous diagnosed appendicitis (OR 3.447, P < 0.0001) Conclusion: From our study, we could conclude that previous acute appendicitis may increased the risk of consequnt colon cancer. So we suggest that if a patient were presented with suspicious symptoms, a preoperative computed tomography scan or a lower midline incision should be performed instead of the McBurney incision, and that patients with acute appendicitis and older than 40 years should undergo colonoscopy 6 weeks post-appendectomy, to exclude the possibility of coexisting colorectal cancers. Finally, a perspective cohort study may be performed in the future to further confirm the correction between appendicitis and colorectal cancer.
參考文獻
延伸閱讀
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