臺灣博碩士論文加值系統

良性前列腺增生所產生的下泌尿道症狀，是影響老年人生活品質最常見的疾病。手術治療是當中最有效也最迅速能夠改善症狀的治療方式，目前以經尿道前列腺切除術(TURP)做為治療前列腺肥大的指標性手術。近年來，雷射前列腺汽化術(PVP)因具有效果穩定以及副作用少的優點，遂逐漸取代成為前列腺主要手術之一。過去文獻多以比較兩者手術的醫療成效與副作用為主，但是在病患手術後的生活品質以及醫療耗用卻較少探討，本研究乃以病患術後生活品質與成本效果分析為主題進行探討。
本研究樣本以北部某醫學中心泌尿外科門診病患，TURP組有30位，PVP組40位，研究期間為2009年4月至2010年4月。收集其術前的年齡、教育程度、婚姻狀況、收入、醫師別，並測量前列腺體積、最大尿流速、尿後餘尿量、國際前列腺症狀分數、尿管時數、住院日數、相關併發症、生活品質、各項費用等，以單變項統計之t檢定與卡方檢定進行初步相關探索，並以多變項迴歸進行模型建構。
研究結果發現，PVP手術在住院天數、尿管時數上顯著低於TURP組，但在最大尿流速、尿後餘尿量、併發症的發生率上兩手術並無統計顯著差異。將醫療成本納入考慮後，發現TURP手術於最大尿流速、尿後餘尿量、併發症發生率、前列腺症狀分數與生活品質上，比PVP手術擁有較好的成本效果比。
本研究以臨床樣本分析TURP及PVP手術之各項預後指標其所顯示之療效指標，可提供未來診療決策參考，而所揭露之成本效果分析結果，對未來病患自費項目選擇，亦提供重要參考價值，未來醫療技術的引進，亦可以此研究方法，發展出一套可供遵循之評核模式。

Lower urinary tract symptoms due to benign prostatic hyperplasia are the most common problems affecting quality of life among the aging male population. Surgeries remain the most efficient modality for symptoms attenuation. Transurethral resection of the prostate (TURP) has been the most commonly used procedure for benign prostatic hyperplasia in the past years. However, a new surgival method, Photoselective vaporization of the prostate (PVP), was introduced as a safer alternative in the recent years. Literatures have demonstrated that efficacy and side effects might be different between these two alternatives. However, post-operation quality of life and medical consumptions were granted as more critical indicators for such patitens but few researches were found to address. Therefore, this study aims to analyze the quality of life and medical consumptions between the two surgical procedures. A cost-effectiveness analysis is performed to provide economic perspectives for future applications.
The study samples were drawn from the outpatient department of urology in a medical center located in north Taiwan. A total of 30 patients were successfully collected as TURP group and 40 subjects were from PVP group during April 2009 - April 2010. The variables collected from this study included patient’s age, education, marital status, income, surgeons, measure prostate volume, maximum urinary flow rate(Qmax), post-void residual urine volume(PVR), International Prostatic Symptom Score(IPSS), catheterization time, hospital stays, complications, quality of life (QoL), item-specifc medical expenditures. Univariate analyses were performed with t test and Chi-square for exploring the primary associated factor. Multiple regression models were applied to construct models for evaluation.
The findings of this study have demonstrated that hospital stays and catheter time were major indicators lower in PVP group than TURP group. Important factors previously mentioned were found to be no statistically significant in this study, including Qmax, PVR, complication rate, IPSS, and QoL. TURP was found with better performance in cost effectiveness analysis than PVP interms of Qmax, PVR, complication rate, prostate volume, and post-surgery QoL.
The study has shown prognosis indicators associated with the methods of surgery, which has provided valuable information for future clinical decisions. The results from cost-effectiveness analysis give clues for patitent’s decision on choosing treatment required out-of-pocket payments. The protocol of resolving controversial issues in introducing new medical technologies as demonstrated by this study can be further modified as a standard for evaluation in situations alike.

目 錄
長庚大學博（碩）士學位論文指導教授推薦書 i
口試委員審定書 ii
長庚大學博碩士論文著作授權書 iii
誌謝 iv
中文摘要 v
Abstract vii
目 錄 ix
第一章 緒論 1
第一節 研究背景 1
第二節 研究目的 2
第二章 文獻探討 3
第一節 前列腺肥大的治療方式 3
第二節 前列腺肥大手術之比較 6
第三節 生活品質之相關概念 9
第四節 前列腺相關生活品質的測量 11
第三章 材料與方法 13
第一節 研究設計 13
第二節 研究假說 14
第三節 研究對象與材料 14
第四節 研究變項 16
第五節 資料處理與分析 18
第四章 結果 19
第一節 樣本特性分析 19
第二節 手術別之預後指標相關模型分析 27
第三節 成本效果分析 32
第五章 討論 37
第一節 研究結果討論 37
第二節 衍生之管理意涵 46
第三節 研究限制 48
第六章 結論與建議 49
第一節 研究結論 49
第二節 研究建議 50
參考文獻 51

表目錄
表4-1-2 術前類別變項之單變項分析 25
表4-1-3術後連續變項之單變項分析 26
表4-1-4 術後併發症之單變項分析 26
表4-1-5 生活品質問卷之描述性統計 26
表4-2-1 生理及臨床指標之相關因素模型 30
表4-2-2 生活品質量表之相關因素模型 31
表4-3-1 前列腺手術費用明細 36
表4-3-2 自費與申報金額之多變項分析 36

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