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研究生:謝淑慧
研究生(外文):Shu-Hui
論文名稱:肺癌患者就診背景分析以中部某醫學中心為例
論文名稱(外文):Analysis the Background of Lung Cancer Patients From A Medical Center in Central of Taiwan
指導教授:周明智周明智引用關係鄭雅文鄭雅文引用關係
指導教授(外文):Ming-Chih Chou
學位類別:碩士
校院名稱:中山醫學大學
系所名稱:醫學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2008
畢業學年度:96
語文別:中文
論文頁數:75
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本研究旨在探討中部某醫學中心肺癌就診患者背景分析。採立意取樣方式。研究設計以中部某醫學中心肺癌患者為研究對象,研究收案納入255名研究個案,分別是男性病例155位及女性病例100位,進行結構式問卷訪談收集資料,所得資料收集、建檔並去除無效問卷,所有資料以SPSS 13.0版統計軟體分析。針對於研究對象的基本人口學特質,如果是連續變項以平均值 ± 標準差 ( mean ± SD ) 呈現,類別變項以百分比 ( % ) 呈現。研究中發現年齡在男性與女性研究對象並無達到統計顯著差異 ( P=0.116;t-test )。相較於男性研究對象的 【 1 】教育程度:女性研究對象在不識字與小學教育程度相較男性研究對象有較高的比率 ( 80.6% vs 64.5%; P=0.007, x2-test )。 【 2 】婚姻狀況:女性研究對象有配偶與男性研究對象婚姻狀況比較,(86% vs. 92%; P=0.052; x2-test ), 【 3 】職業類型:女性研究對象以家庭主婦 ( 29.5% ) 與農漁牧 ( 27.3% )比例較高,男性研究對象從事運輸與製造業 ( 35.8% ) 和農漁牧 ( 34.4% ) 有較高的比例。顯示男性病例與女性病例在環境的暴露因子不同。 【 4 】在肺癌細胞型態上發現女性研究對象以罹患肺腺癌 ( 74.0% ) 居多,男性研究對象則以罹患肺腺癌 (50.3%) 和麟狀細胞癌 (30.3%) 占多數,由此可得知男性與女性在肺癌型態上雖然同樣居於多數,但男性在鱗狀細胞癌的部份仍佔高的比率,可能與暴露不同的危險因子有正相關。 【 5 】抽煙習慣:研究中發現,男性研究對象較女性研究對象具有較高比率之抽菸習慣 ( 81.2% vs. 11.6%;P<0.001 )。 【 6 】生活習慣上:男性在工作場所同事在旁抽菸比率 ( 43.6% vs. 65.7% ; P = 0.002 ) 、喝酒習慣 ( 7.3% vs. 41.9% ; P = 0.001 )、喝茶習慣( 34.4% vs. 63.2%; P = <0.001 )與嚼食檳榔習慣(3.2% vs. 29.9% ; P = <0.001 ),男性皆比女性病例有高。 【 7 】二手煙:女性研究對象較男性在二手煙的環境暴露高 ( 91.3% vs. 71.7%; P = 0.001 )。 【 8 】油煙、拜香及蚊香暴露:女性病例有較高的(炒菜)油煙暴露 ( 33.0% vs. 23.4% ; P=0.224 ),排煙機使用 ( 90.1% vs. 84.6% ; P= 0.239 )。男性則在蚊香 ( 54.3% vs. 50.7 ; P=0.583 ) 及拜香暴露 ( 75.0% vs. 74.2% ; P = 0.884 )則與女性差異不大。在統計研究中男性抽菸為肺癌的主要致病因子,女性則有高的二手菸暴露及廚房油煙暴露,但由男、女職業分佈中,懷疑工作環境的暴露是中部地區肺癌重要致病因子。



The aim of this study is to analyze the backgrounds of lung cancer patients from a medical center in Taichung. The subjects enrolled in this study were all primary lung cancer patients from this hospital.
Descriptive statistics were used for the method of study. Questionnaires were administered to 155 male and 100 female primary lung cancer patients. The data were collected by processing structured questionnaire interviews and then statistically analyzed by SPSS 13.0. The following findings are based on the statistical analysis.
The method was based on demographic characteristics. The age, sex, marital status, education, occupation, and morphology, cancer staging for continuous variable mean value ± standard deviation (mean ± SD), percentages (%) to show the categorical variables, and the chi-square test (x2-test) for variables.
Age and Marital Status: The mean age for subjects and controls was 68.0 ± 12.9 years (standard deviation [SD]) for the females and 70.3 ± 11.0 years for the males, P=0.116 (t test). There was no statistically significant difference between the two groups. There was no significant difference between female and male subjects with single marital status (including single, separated, divorced, or widowed) (86.0% vs. 92.0%, P=0.052; x2-test).
Education: Illiteracy and elementary education had the largest distribution among the subjects. The statistics show that the females had a higher rate of illiteracy and fewer had elementary education compared to the males (80.6% vs. 64.5%;x2-test).
Occupations: Among the female subjects 29.5% were homemakers and 27.3% were farmers. More of the male subjects worked in transportation or the manufacturing industry (35.8%), and 34.4% were farmers (29.5% vs. 35.8%, P<0.001; x2-test). The results show that males are more exposed to work place environments than females. It is also means that females and males have different risk factors.
Morphology: All subjects had histologically confirmed primary lung cancer. The results show that there were 74 (74.4%) females with adenocarcinoma and 13 (13%) with squamous cell carcinoma, and for the males, 78 (50.3%) had adenocarcinoma and 47 (30.3%) had squamous cell carcinoma. A statistically significant difference was found between the females and males with adenocarcinoma. (74.4% vs. 50.3%, P=0.002; x2-test) has statistical significance different. Adenocacinoma is the most common type of lung cancer seen in the human population and it is also the most frequently occurring cell type in female nonsmokers. Squamous cell carcinoma is commonly seen in male smokers. The data show that with respect to female and male primary lung cancer, males might have more exposure to different environments compared to females.
Smoking status: In our study, the number of male smokers was higher than female smokers (81.2% vs. 11.6%; P<0.001 x2-test), but female subjects were more exposed to passive smoking environments than males, (91.3% vs. 71.7%; P=0.001 x2-test). This result is similar to other epidemiological studies in Taiwan.
Lifestyles: Our study also revealed that male subjects had more passive smoking experiences in their working environments. They also drink more alcohol and tea and chew betel nut more than the females.
Exposure to cooking oil fumes, incense, and mosquito coil: Comparing females and males, the female subjects had more exposure to cooking fumes and extractor fans in kitchens than males 82 ( 90.1% ) vs. 44 ( 84.6% ) However, there was no statistically significant difference for incense and mosquito coil exposure ( P=0.101 ).
Epidemiologic studies have demonstrated that cigarette smoking is the most important risk factor for male primary lung caner patients, but for female non-smokers, exposure to cooking oil fumes and passive smoking may be an important factor in causing lung cancer in Taiwanese women who are non-smokers.


誌謝 ..………………………………………………………………. Ⅰ
目錄 ..………………………………………………………………. Ⅲ
英文縮寫 ………………………………………………………….. Ⅶ
中文摘要 ………………………………………………………….. 1
英文摘要 ………………………………………………………….. 3
第一章 緒論 ……………………………………………………… 6
第二章 研究目的 ………………………………………………… 8
第三章 文獻綜論
第一節 肺癌的細胞組織與癌症分期 ……………………... 9
第二節 抽菸與肺癌形成之相關性 ………………………… 10
第三節 二手菸與肺癌形成之相關性 …………………….... 11
第四節 性別、環境與肺癌之相關性……………………...... 12
第五節 廚房油煙與肺癌形成之相關性…………………….. 16
第六節 在工作環境的致癌物質與肺癌形成之相關性…….. 17
第七節 蚊香及拜香與肺癌形成之相關性………………….. 18
第八節 教育程度和職業環境暴露與肺癌之相關性……….. 18
第四章 材料與方法 21
第一節 研究設計與研究對象……………………................. 21
第二節 研究工具……………………..................................... 21
第三節 研究工具信效度測驗……………………................ 22
第四節 研究實施步驟 ……………………............................ 23
第五節 資料統計與統計分析方法 ……………………....... 24
第六節 研究對象保護措施……………………..................... 24
第五章 研究結果與分析……………………......................... 26
1、 女性病例組與男性研究對象之年齡比較……… 26
2、 以年齡分層分析顯示…………………….............. 26
3、 婚姻狀況…………………….................................... 27
4、 教育程度分析……………………........................... 27
5、 職業分析……………………... …………………… 28
6、 肺癌細胞病理型態之結果分析…………………. 28
7、 癌症期別分析……………………........................... 30
8、 抽菸與二手菸暴露分析……………………........ 30
9、 酒、飲茶與吃檳榔習慣情形分析…………………… 31
10、 烹調方式分析…………………….............................. 31
11、 拜香環境暴露分析……………………...................... 31
12、 蚊香暴露分析 ……………………............................ 31
13、 女性研究對象之月經及生產史分析………………. 33
14、 研究對象之個人疾病史與家人健康狀況…………. 34
15、 研究對象居住地區統計…………………….............. 34
16、 研究對象與醫學中心五年存活率比較…………….. 35
第六章 討論………………………………………………….. 37
第七章 結論與建議 ………………………………………… 39
第八章 研究限制及未來研究方向………………………….. 42
參考資料 ………………………………………………………… 43
圖表目錄
表一 研究對象之基本資料 …………………………………… 50
表二 研究對象之生活習慣 …. ………………………………. 51
表三 女性研究對象之月經及生產史…………………………. 52
表四 研究對象個人疾病史及家族疾病史……………………. 53
表五 在性別差異上的油煙環境之分層分析…………………. 54
表六 在性別分佈的差異上的抽菸與蚊香暴露之分層分析…………………………………………………………………… 54
表七 在性別分佈的差異上的抽菸與拜香暴露之分層分析… 54
表八 在性別分佈的差異上排煙與蚊香暴露之分層分析…… 55
表九 在性別分佈的差異上排煙與拜香暴露之分層分析…… 55
表十 在性別分佈的差異上蚊香暴露與拜香暴露之分層分析.. 55
表十一 研究對象性別、癌症期別與教育程度交叉表………… 56
表十二 患者居住地區統計……………………………………… 57
表十三 2002-2006 五年存活率統計表 ……………………….. 58

附錄目錄
附錄一 調查問卷 ………………………………………………… 59
附錄二 效度評量專家名單 ……………………………………… 69
附錄三 問卷內容效度檢定 ……………………………………… 70
附錄四 問卷內容效度表 ………………………………………… 75


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行政院衛生署 歷年男性死亡原因http:www.doh.gov.tw/statistic/data衛生統計叢書2/95/上冊/表11.xls
行政院衛生署 歷年女性死亡原因http:www.doh.gov.tw/statistic/data/衛生統計叢書2/95/上冊/ 表12.xls
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厚労省がん研究班編/医療・GL(06年)有効性評価に基づく肺癌検診ガイドライン肺癌の頻度と予後http://minds.jcqhc.or.jp/0041_ContentsTop.html

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