- 學位論文
以前瞻性評估腹腔鏡膽囊切除術手術量與術後療效之相關性：系統性回顧與統合分析
The Association between Volume-Outcome in Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis
摘要
中文摘要 研究目的 膽囊切除術為目前很普遍的手術，鮮少有研究針對長期的術後療效，因此，本研究目的為透過長期追蹤，探討膽囊切除病患之改善趨勢，比較GIQLI與SF-36評估量表各構面在高手術與低手術量的分數變化，根據資料庫內容探討評估術後病患狀況的各項指標，針對過去手術量與術後療效相關文獻做統合分析。 研究方法 本研究針對2006年5月至2009年5月間，共有522於兩家醫學中心接受膽囊切除術患者為研究樣本、追蹤時間點分為術前、術後三月、術後一年、術後兩年及術後五年，透過SF-36及GIQLI兩種評估量表做各時間點身心狀況的紀錄。分析方法以廣義估計方程式(The Generalized Estimating Equations，GEE)做各時間點構面分數的趨勢分析。以線性回歸和二元邏輯斯回歸探討住院天數和併發症發生率，並針對醫院的手術量及醫師手術量與術後療效進行系統性文獻回顧與統合分析。 研究結果 本研究樣本以女性居多(57.25%)，平均年齡為54.80(標準差為14.90)歲，小於65歲佔72.9%。研究結果顯示患者於術後各時間點在SF-36以及GIQLI各構面都有顯著性的改善(p<0.001)，在控制時間因素及其它干擾因素後，高手術量醫師其病患在術後SF-36及GIQLI各構面皆較低手術量醫師的病患有較高的分數。前瞻性研究之住院天數高手術量醫師少了0.92天，併發症之OR值為0.07；統合分析結果高手術量住院天數少了1.97天，併發症發生率則沒有達到統計顯著意義(p=0.107)。 結論與建議 經過長期的追蹤，膽囊切除術病患在術後皆擁有不錯的恢復成效，並且在高手術量的醫師治療下有較好的術後療效，建議醫療機構可針對患者建立優良的術後追蹤管理。
並列摘要
英文摘要 Purpose Laparoscopic Cholecystectomy is a widespread surgery. Few studies aimed at the long term postoperative outcomes, and therefore this study purposed to invetigate the long-term trend of cholecystectomy. Comparing the change of GIQLI and SF-36 scores in each dimensions classify in high volume and low volume surgeons. First, a prospective cohort study was performed in a large database. Second, a systematic review and a meta-analysis of the relevant literature were performed. Methods A tatole of 522 cholecystectomy surgery patients from two Academic Medical Centers were recruited from 2006 to 2009. All patients completed SF-36 and GIQLI at preoperative, 3rd month, 1st year, 2nd year, 5th year after surgery. The generalized estimating equation (GEE) model was employed for trend analysis, and in conjunction with the prospective study, a systematic review and meta-analysis of the relevant literature also were performed. The random fixed effect was used to investigate length of stay and complication rate after cholecystectomy. Results Most of the sample are female (57.25%) and under 65 years old (72.9%). The average age is 54.80(SD: 14.90). Every dimensions of SF-36 and GIQLI are significantly improved postoperative (p<0.001). High volume surgeon has shorter length of stay (-0.92day), and lower complication rate (OR=0.07). In meta-analysis, high volume surgeon has shorter length of stay (-1.97day), but complication rate is not significant (p=0.107). Conclusions After tracking for long term, the postoperative result of cholecystectomy patients have recovered splendid, and the outcome is better by the high-volume surgeon. Medical institutions should establish the postoperative management system to tracing patient's condition.
參考文獻
延伸閱讀
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