臺灣博碩士論文加值系統

研究背景: 根據衛生署統計資料顯示，96年死於膀胱癌的病人有804人列惡性腫瘤死亡榜之15名，較95年提升1名，每10萬人口死亡率由3.0人增加成3.5人。膀胱癌雖好發在50～70歲間的年齡層，但在20~24歲間的年齡層也有初次診斷之案例。膀胱癌的症狀主要為無痛性血尿，主要診斷方式為尿液細胞學檢查和病理組織切片診斷。
研究目的： 於中部某一醫學中心，經由醫品圈之活動及教育訓練已使得一般檢驗科負責尿液沈渣鏡檢的醫檢師具備對異常泌尿上皮細胞的辨識能力的背景下，欲評估於尿液常規之尿液沈渣鏡檢下，辨識出異常移形上皮細胞，來篩檢膀胱癌的表現及價值。並使用回溯性研究的方法，觀察血尿與膀胱癌的關係；同時，分析經由病理組織切片確診的泌尿上皮細胞癌的病人其臨床表現與細胞學及病理組織切片診斷的相關性。
材料與方法: 自97年6月至8月，一般檢驗科之所有尿液常規檢體，當中發現異常泌尿上皮細胞病例的剩餘尿液沉渣檢體，會經由細胞病理科檢體處理程序，醫檢師閱片再由病理醫師診斷。將診斷為泌尿上皮癌的臨床追蹤時間訂為97年12月底止，並自醫院及病理資訊系統中，收集相關數據。
研究結果： 自97年6月至 8月共有14482人的尿液常規檢體, 總共自尿液沉渣鏡檢辨識出異常泌尿上皮細胞共60例，5例經病理組織切片診斷為泌尿上皮細胞癌(LR+為25；LR-為0.904)；當中的4192人 (29%) 在尿液沉渣鏡檢高倍的視野下發現大於及包含3顆紅血球的血尿(與泌尿上皮癌的關係: LR+為2.08；LR-為0.56)。絕大部分的血尿病人分布於腎臟科和免疫風濕科。
至泌尿外科就診有做尿液常規的1668個病人中，總共辨識出22例異常泌尿上皮細胞，5例經病理組織切片診斷為泌尿上皮細胞癌(LR+為9.09；LR-為0.91)；有537人(佔泌尿外科病人的32%；只佔全部血尿病人的13%,) 發現有大於3顆及包含紅血球的血尿(與泌尿上皮癌的關係: LR+為1.9；LR-為0.58)。
結論與建議： 目前尚未證實有能提供符合臨床效益的敏感性及特異性需求之通用篩檢方法。本回顧性的研究針對97年6月至97年8月這三個月至醫學中心全院各科就診的病人，將辨識異常泌尿上皮細胞的篩檢提前於尿液常規中的尿液沉渣鏡檢執行，診斷的表現評估方面概似比(LR)有充分的並且決定性的增加或排除罹病的可能性。在成本效益方面，將能運用最低的醫療成本，達到最佳的膀胱癌早期偵測價值，達到早期診斷、早期治療的目標，以保障病患健康。

Background: The statistics of Department of Health, Executive Yuan, of Taiwan R.O.C. reveals that 804 persons were died from bladder cancer in 2007, the fifteenth cause of cancer. The mortality rate increased from 3.0 to 3.5 persons per 100,000 populations from 2006 to 2007. Although the peak age of bladder cancer is fifty to seventy years old, there is still most frequent diagnosed disease in the younger age, even the age of twenty to twenty four years old. The major symptom of bladder cancer is hematuria, and diagnosis is made by urine cytology and pathological tissue biopsy.
Objectives: To evaluate the application and value of identifying atypical transitional cells in routine urinalysis in the background of trained medical technology in the first line, to correlate the expression of hematuria (micro or gross) with bladder cancer, and to analyze the clinicopathological features and correlate the diagnosis of cytology and pathology in the patients with bladder cancer.
Materials and Methods: All consecutive specimens of urine routine collected in the general laboratory will be examined. Those specimens of urine sediment in which atypical transitional cells are identified will be further fixed, stained and reviewed in the cytological laboratory. The clinic-follow-up deadline is on December 31, 2008. Data is collected from hospital and pathological information system.
Results: There are sixty cases of atypical urothelial cells in 14482 patients from June to August 2008, and five of them is urothelial carcinoma by biopsy (LR+: 25; LR-: 0.904).The presence of greater than three RBCs per high-power field is found in the 4192 cases (29%), the LR+ of urothelial carcinoma is 2.08; and LR- is 0.56). The majority of patent with hematuria is followed up in the clinic of nephrology and rheumatology.
One thousand six hundred and sixty eight patients are from urologic clinic. Twenty two cases of atypical urothelial cells are identified, in which five cases is urothelial carcinoma by biopsy (LR+: 9.09; LR-: 0.91). Five hundred thirty seven patients have hematuria as mentioned above, and the likelihood with urothelial carcinoma is LR+: 1.9; LR-: 0.58).
Conclusion: No efficient screening test is available for screening
bladder malignancy. This retrospective study aims to identify atypical urothelial cells in urinalysis sediment seems to show significant likelihood of urothelial carcinoma, and has sufficient evidence to ruled in or ruled out urothelial carcinoma in the all cases. The proposed test for identifying the malignant urothelial cells in routine urine specimen is beneficial for diagnosis, cost reduction, efficient management and prognosis for urothelial cell malignancy.

摘要..................................................I
Abstract.............................................II
誌 謝...............................................III
目 錄................................................IV
圖 索 引..............................................V
表 索 引............................................ VI


第一章 緒論...........................................1
1-1 前言..............................................1
1-2 研究背景..........................................2
1-3 國內外研究情形....................................5
1-4 研究目的..........................................7
第二章 研究設計過程與理論基礎.........................8
2-1 研究設計過程......................................8
2-2 理論基礎..........................................9
第三章 材料與方法....................................13
3-1 材料.............................................13
3-2 作業流程.........................................14
3-3 研究流程及方法...................................16
3-4 統計方法.........................................18
第四章 結果與討論....................................27
4-1 收案結果與分析...................................27

4-2 診斷比對結果.....................................31
4-3 統計結果...................................36
4-4 討論.............................................48
第五章 結論及未來展望................................59
5-1 結論.............................................59
5-2 研究之貢獻.......................................63
5-3 未來展望.........................................65
參考文獻.............................................66
作者自述.............................................72

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