背景與目的:導尿管留置是現今相當普遍的醫療處置,同時也是居家照護常有的醫療措施,許多研究皆有提到留置導尿管的缺點,雖然曾有研究提及留置導尿管會罹患膀胱癌,但並未進行實證研究,故本論文透過分析健保資料庫,探討長期導尿管放置時病人罹患尿路相關癌症的風險。 材料與方法:採回溯性研究,使用1997年至2013年全民健康健保資料庫,選樣標準為符合ICD-9-CM中診斷代碼為尿路癌症(ICD-9-CM前3/4碼為185、187、188、189.3、189.4)之個案。選樣排除小於20歲之個案或罹患尿路相關癌症前已罹患其他癌症(ICD-9-CM代碼為140~239),並以全民健康保險醫療服務給付項目及支付標準為導尿管篩選條件,並計算傾向分數以樣本配對1:2比例、1:3比例、1:4比例挑選出有罹患尿路相關癌症且沒有放置導尿管者為對照組。 結果與結論:結果顯示,導尿管留置至罹癌期間超過2年,有留置導尿管與未留置導尿管樣本配對比例採1:2、1:3、1:4者,罹癌風險為8.714、9.771、10.929倍;有留置導尿管至罹癌期間超過1年,未留置導尿管樣本配對比例採1:2、1:3、1:4者,罹癌風險為9.569、11.074、12.985倍,上述罹癌風險比皆達統計上顯著差異。依據上述結果推論,導尿管留置至罹患癌症期間超過2年為基準或以1年為基準,皆達統計上顯著差異,皆可有效應用,而傾向分數樣本配對比例應採用1:2比例、1:3比例或是1:4比例,以上三種樣本配對比例皆可有效應用。
Background and Goals:Foley care is currently a common treatment for both hospitals and home care. Despite many researchers suspecting that using foley may relate to the onset of bladder cancer, little evidence however can affirm this relationship. The aim of this study is to investigate the hazard ratio of onset of urinary cancer between patients with and without long-term foley placement. Materials and Methods:The design of this research is retrospective with secondary data analysis. The data used for this study is extracted from National Health Insurance Database between 1997 and 2013. Eligibility criteria for study subjects were that a patient must (1) be diagnosed through an international classification of diseases, ninth revision, clinical modification (ICD-9-CM) starting with 185, 187, 188, 189.3, or 189.4 and (2) aged over 20. Patients with urinary-related cancer and long-term foley placement were matched by propensity score matching approach as control group subjects at a 1:2, 1:3, and 1:4 ratio, respectively. Results and Conclusions:The results show that the hazard ratio of the onset of bladder cancer for patients with more than two years of foley placement is 8.714, 9.771, and 10.929 times higher than those patients without foley placement for matching ration of 1:2, 1:3, and 1:4, respectively. Further, the hazard ratio of the onset of urinary cancer for patients with more than one year of foley placement is 9.569, 11.074, and 12.985 times higher than those patients without foley placement for matching ration of 1:2, 1:3, and 1:4, respectively. All hazard ratios are significant at a 0.05 level. One year or two years of foley placement can be used as a criterion for filtering study subjects. Further, propensity score matching of 1:2, 1:3, and 1:4 ratio show similar results.