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研究生:柯芳序
研究生(外文):Fang-Chu Ko
論文名稱:成人健康檢查中糞便潛血反應之效益評估
論文名稱(外文):Effectiveness of Stool Occult Blood Test on Adult Preventive Health Care Service
指導教授:李偉強李偉強引用關係
指導教授(外文):Wui-Chiang Lee
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:醫務管理研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:中文
論文頁數:55
中文關鍵詞:大腸直腸癌糞便潛血反應檢查大腸鏡篩檢準則
外文關鍵詞:Colon-rectal cancerimmunoassay stool occult blood testcolonoscopy
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大腸直腸癌長年來一直位居台灣十大惡性腫瘤發生率的第三位,近年來更有逐漸上升的趨勢,而且大腸直腸癌並沒有良好的防治手段可以降低其發生率,唯一可以減低其衝擊的方法只有早期發現與早期治療。每年政府花了許多人力與物力進行大規模的大腸直腸癌篩檢,但很少有其效益評估,本研究的目的是希望了解將免疫法糞便潛血檢查應用在成人健康檢查當中的效益,是否可以確實達到早期發現大腸直腸癌的目的及其經濟效益。

本研究收集民國92年1月到96年12月在行政院衛生署基隆醫院執行之所有大腸鏡報告,總共有2849位受檢者納入研究之中,再將受檢者依照求診原因區分為門診組以及潛血組,統計其大腸鏡檢查發現並對兩組間之差異加以分析。

結果發現免疫法糞便潛血反應檢查在發現大腸直腸瘜肉上有顯著的效益,在40歲以上的陽性受檢者當中其發現率高達29%。在大腸直腸癌的發現上,潛血組的發現率為2.82%,而門診組的發現率是7.38%,而在腫瘤的期別分布上只有第一期腫瘤明顯出現潛血組高於門診組的情形。透過敏感度分析,我們發現大腸直腸癌的發現對於年齡有一個最佳的篩檢建議值出現在55歲;相對的,大腸直腸癌的發現對於糞便潛血反應數值也有一個最佳的篩檢建議值落在587.0。在費用耗用上,潛血組平均每發現一名大腸直腸癌患者所花費的金額是181,426元,而門診組平均每發現一位大腸直腸癌患者所花費的金額是30,483元。

我們建議的大腸直腸癌篩檢準則是:無論任何年齡,沒有症狀之民眾可以先進行糞便潛血檢查以作為初步之篩檢,但若是有任何相關症狀或是已經年滿55歲而未接受過大腸鏡檢查者,則可以逕行安排大腸鏡檢查。
Colon-rectal cancer is the third popular malignant disease in Taiwan, and the incidence is still rising in these years. Since there is no effective method to decrease the occurrence of colon-rectal cancer, the only way to diminish the impact is to diagnose and treat colon-rectal cancer in its early stage. The local healthcare authorities arranged large-scale colon-rectal cancer screenings every year, but the cost-effectiveness of the screening has been rarely studied. Therefore, the aim of this study was to examine the effectiveness of stool occult blood test on adult preventive health care service and whether it can discover colon-rectal cancer in early stage.

We collected all colonoscopy reports at Keelung hospital, from January 2004 till December 2007. A total of 2849 patients were enrolled in this study. We divided these patients into the out-patient groups and stool-OB group according to the reason they received colonoscopy examination (the out-patient groups and stool-OB group), then compare the difference between their colonoscopy examination results.

We found that the immunoassay stool occult blood test was effective in identifying colon-rectal polyps and the incidence was about 29% in those who had positive stool examination results. The incidence of colon-rectal cancer was 2.82% in stool-OB group and 7.38% in out-patient group. In stage distribution, only stage one significantly increased in the stool-OB group then in the out-patient group, otherwise no difference was noted between these two groups. We found that a recommended screening age by means of sensitivity analysis for colon-rectal cancer at 55 years old. Additionally, the recommended screening data for immunoassay stool occult blood test result was 587 U/dl. On average, each colon-rectal cancer patient cost NT 181,426 dollars when diagnosed in the stool-OB group and NT 30,483 dollars in the out-patient group.

We suggest a screening principle for colon-rectal cancer in Taiwan is:those who doesn’t experience any clinical symptoms should receive immunoassay stool occult blood test for screening, but if one had any associated symptoms or never receiving colonoscopy examination before age of 55, colonoscopy examination is a recommended tool for screening of colon-rectal cancer.
論文電子檔著作權授權書………………………………………………i
論文審定同意書………………………………………………………ii
誌謝……………………………………………………………………iii
中文摘要………………………………………………………………iv
英文摘要………………………………………………………………v
目錄……………………………………………………………………vii
圖目錄…………………………………………………………………ix
表目錄…………………………………………………………………x
第一章 緒論(Introduction)………………………………………1
第一節 研究背景與動機(Study Background)……………1
第二節 研究問題(Research Questions)…………………3
第三節 研究重要性(Significance of the Study)……4
第四節 研究目的(Study Purpose)………………5
第二章 文獻探討(Literature Review)……………………………6
第三章 研究設計與方法(Methodology)……………………………11
第一節 研究架構(Conceptual Framework)……………11
第二節 研究假設(Research Hypotheses)……………12
第三節 研究對象與資料來源(Study Object or Data Source)………………13
第四節 研究工具(Research Instrument)………………14
第五節 測量方法(Measurements)………………………15
第六節 分析方法(Analytical Methods)………………17
第四章 結果(Results)………………………………………………18
第一節 全體病患之資料分析………………………………………19
第二節 潛血組患者與門診組患者之變項分析……………………21
第三節 瘜肉及癌症患者之變項分析………………………………24
第四節 潛血指數與其他變項之分析………………………………27
第五節 敏感度分析…………………………………………………31

第五章 討論(Discussion)…………………………………………34
第一節 大腸鏡檢查發現……………………………………………34
第二節 糞便潛血檢查之效益………………………………………40
第三節 大腸鏡檢查篩檢準則………………………………………44
第四節 研究限制(Research Limitations)………………………46
第六章 結論與建議(Conclusion and Recommendations)………49
研究結論(Conclusion)…………………………………49
建議(Recommendations)………………………………51
參考文獻(Bibliographies)………………………………………53
行政院衛生署國民健康局臺灣癌症登記小組癌症年報.

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