臺灣博碩士論文加值系統

背景與目的：瞭解台灣甲狀腺癌患者接受碘-131治療的年齡、性別及劑量分布情形，以及各劑量再治療率及時間間隔。

材料與方法：從全民健康保險研究資料庫中擷取甲狀腺癌患者，利用描述性統計分析其首次接受碘-131治療的年齡、性別及劑量分布情形。並依照首次劑量及手術類型分組，追蹤其再度接受碘-131治療的比例與時間間隔。

結果 : 從2000 年至2013 年，甲狀腺癌總人數從290 人上升至1,096，盛行率從每十萬人46 人上升至每十萬人151 人，碘-131治療首次劑量的使用趨勢，以30 mCi為大宗；住院受檢者首次碘-131劑量以100 mCi居冠，台灣甲狀腺癌患者年齡分佈受檢率最高的年齡層是41~50歲(26.6%)。首次接受30 mCi、100 mCi、120 mCi以及150 mCi治療的受檢者，再接受治療的比例為40.4%、27.3%、43%及41.7%，平均次數為2.6、1.68、2.3及1.7次，平均再治療劑量分別為46.3±37.8 mCi、99.0±50.5 mCi、106.5±48.5 mCi、119.5±53.0 mCi。探討手術切除類型結合碘-131治療，以單側甲狀腺全葉切除術結合80 mCi、根治性甲狀腺切除術結合120 mCi、單側甲狀腺全葉切除術及另一側次全甲狀腺切除術結合100 mCi，以及雙側甲狀腺全葉切除術結合120 mCi，再治療時間間隔最長。

結論 : 台灣甲狀腺癌患者接受碘-131治療中，以首次劑量100 mCi者的再治療比例及次數為最低。針對不同類型甲狀腺癌手術，則有不同的最佳劑量組合，劑量介於80至120 mCi之間。

Background：To investigate the age, gender and dose distribution of iodine-131 treatment in patients with thyroid cancer in Taiwan, as well as the retreatment rate and time interval of each dose.
Materials & methods：Based on the National Health Insurance Research Database (NHIRD), patients underwent I-131 treatment for thyroid cancer were selected. Descriptive statistics were used to analyze the age, gender, and dose distribution of iodine-131 treatment for the first time. According to the first dose and type of surgery, the proportion and time interval of reaccepting iodine-131 treatment were studied.
Results：From 2000 to 2013, the total number of thyroid cancers rose from 290 to 1,096 in 800 thousand study population, and the prevalence rose from 46 to 151 per 100,000 people. The most dose of iodine 131 treatment was 30 mCi for outpatients; the most dose of I-131 for hospitalized patients was 100 mCi. The most age group of I-131 treatment for thyroid cancer was 41-50 years old (26.6%). The patients receiving 30 mCi, 100 mCi, 120 mCi, and 150 mCi first time, their retreatment rate was 40.4%, 27.3%, 43% and 41.7%, respectively. The average retreatment time interval were 2.6, 1.68, 2.3, and 1.7, and the mean dose were 46.3±37.8 mCi、99.0±50.5 mCi、106.5±48.5 mCi、119.5±53.0 mCi, respectively. While the types of surgical resection combined with iodine-131 treatment were investigated in further, unilateral thyroidectomy combined with 80 mCi, radical thyroidectomy combined with 120 mCi, unilateral thyroidectomy and another subtotal thyroidectomy combined with 100 mCi , and bilateral thyroidectomy combined with 120 mCi, the retreatment time interval were longest.
Conclusion：The patients receiving 100 mCi first time have lowest retreatment rate 27.3%. The dose of I-131 combined with different types of thyroid resection were between 80 and 120 mCi with longest retreatment time interval.

第一章 緒論 1
1.1研究背景 1
1.2研究動機 2
1.3研究目的 3
第二章 文獻探討 4
2.1 使用國家健康保險資料庫來看台灣甲狀腺癌盛行率的數據 4
2.2.1 上升趨勢僅限於某些類型的甲狀腺癌 4
2.2 台灣地區甲狀腺癌之流行病學研究 5
2.3 甲狀腺癌深入研究的方向 5
2.4 門診131I治療分化型甲狀腺癌後選定的輻射安全問題 5
2.5 台灣甲狀腺癌發病率和死亡率的趨勢 6
2.6 台灣甲狀腺癌罹患後治療方法與治療時間 7
2.7 甲狀腺癌切除手術指南 9
第三章 材料與方法 13
3.1 研究架構 13
3.2 資料來源 14
3.2.1合併門診處方醫令明細檔 (OO)、門診處方及治療明細檔(CD) 14
3.2.2合併住院醫療費用醫令明細檔(DO)、住院醫療費用清單明細檔(DD) 14
3.3 分析項目 14
3.3.1甲狀腺癌盛行率、年齡分佈 15
3.3.2甲狀腺癌患者的碘-131治療情形 15
3.3.3甲狀腺碘-131治療復發率 15
3.3.4切除手術搭配碘-131之再治療率 15
3.4統計分析 15
第四章 結果 16
4.1台灣甲狀腺癌盛行率 17
4.2台灣甲狀腺癌年齡分佈 24
4.2.1 台灣甲狀腺癌各年齡層之盛行率 26
4.3台灣甲狀腺癌患者首次接受131I治療之劑量分佈情形 28
4.3.1台灣甲狀腺癌患者住院接受首次131I劑量分佈情形 31
4.3.2台灣甲狀腺癌患者門診接受首次131I劑量分佈情形 33
4.4台灣甲狀腺癌患者首次131I劑量使用之性別分佈情形 35
4.5台灣甲狀腺癌全體受檢者首次131I劑量使用之年齡分佈情形 37
4.5.1台灣甲狀腺癌住院患者131I年齡分佈情形 39
4.5.2台灣甲狀腺癌門診受檢者131I年齡分佈情形 40
4.6台灣核醫甲狀腺癌的再治療情形 42
4.6.1首次給30 mCi的第二次再治療情形 43
4.6.2首次給100 mCi的第二次再治療情形 46
4.6.3首次給120 mCi的第二次再治療情形 48
4.6.4首次給150 mCi的第二次再治療情形 51
4.6.5 各劑量再治療之性別分佈情形 53
4.6.6各劑量再治療之年齡分佈情形 55
4.7 甲狀腺切除手術患者接受碘-131治療情形 56
4.7.1單側次全甲狀腺切除術 61
4.7.2雙側次全甲狀腺切除術 63
4.7.4單側甲狀腺全葉切除術 66
4.7.5單側頸部淋巴腺刮除術 68
4.7.6雙側頸部淋巴腺刮除術 70
4.7.7根治性甲狀腺切除術 71
4.7.8單側甲狀腺全葉切除術及另一側次全甲狀腺切除術 73
4.7.9雙側甲狀腺全葉切除術 75
第五章 討論 78
5.1甲狀腺癌碘-131使用情形 78
5.2甲狀腺癌年齡分佈情形 78
5.3再治療情形 78
5.4 常見切除手術前三名搭配碘-131治療之差異探討 79
5.5 研究限制 79
第六章 結論 80
附件一、ICD-9-CM疾病碼 81
附件二、核子醫學醫令代碼 82
附件三、甲狀腺手術醫令碼 85
參考文獻 86

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