臺灣博碩士論文加值系統

肝病為國人之國病，台灣罹患肝病的人數眾多。未控制的慢性肝病直至最後將演變成肝硬化或肝衰竭，最後甚至成為膽管癌及肝細胞癌。在肝臟疾病進行到末期無法以傳統方式治療時僅剩接受肝臟移植一途延續其生命。財團法人器官捐贈移植登錄中心統計2005年至2018年接受肝臟移植手術的女性五年存活率為75.74%、男性為73.28%。影響肝臟移植癒後的因素眾多，國外近年大型研究逐漸著重於性別的配對與否對於術後存活率的影響，但結果並不一致且國內尚缺乏類似研究可供臨床參考。
本研究利用全民健康保險研究資料庫之住院檔，分析2000年至2015年接受肝臟移植手術病人，依性別區分捐贈者配對受贈者後，各組間醫療耗用、五年內死亡率以及後續死亡率的差異。研究結果顯示，男性捐給女性時住院天數最多天(aRR=1.169, P=0.610)，同時男性捐給女性時醫療花費最少(aRR=0.816, P=0.328)，而女性捐給男性時，五年死亡情形最多(aRR=1.549, P=0.518)，且後續死亡情形也最多(aRR=1.612, P=0.478)。但皆無統計上顯著差異。
建議當受肝者為女性時，若能配對女性捐贈肝臟，則會有較少的住院天數及較少的死亡情形；當受肝者為男性時，配對男性捐贈肝臟，則有較少死亡情形。在嚴謹的生理條件匹配及適切的GW/RW比值下，再將性別配對的肝臟移植預後較佳。

As hepatic disease is a national disease, there are many people suffering from it in Taiwan. Uncontrolled chronic hepatic disease progresses to cirrhosis of liver or liver failure, and eventually to biliary cancer and hepatocellular carcinoma. When the end-stage hepatic disease cannot be treated conventionally, the only way to extend life is to receive a liver transplant. According to the Organ Donation and Transplantation Registration Center, the five-year survival rate for women who received liver transplants from 2005 to 2018 was 75.74% and 73.28% for men. There are many variables that affect the survival of liver transplantation. In recent years, large studies overseas have focused on the impact of gender matching on postoperative survival, but the results are inconsistent and there is a lack of similar studies in Taiwan for reference in clinical practice.
In this study, we analyzed the differences in medical costs, five-year mortality rates, and follow-up mortality rates among gender matched and mismatched patients who underwent liver transplantation from 2000 to 2015 by using inpatient files from the National Health Insurance Research Database. The findings showed that M-F had the greatest hospital days (aRR=1.169, P=0.610) and the least medical costs (aRR=0.816, P=0.328), while F-F had the greatest number of five-year deaths (aRR=1.549, P=0.518) and the greatest number of follow-up deaths (aRR=1.612, P=0.478). However, there were no statistically significant differences.
The prognosis of gender-matched liver transplantation is better with strict physiological matching and an appropriate GW/RW ratio.

表目錄 1
圖目錄 2
中文摘要 3
英文摘要 5
第一章 緒論 6
第一節 研究背景與重要性 6
第二節 研究動機 8
第三節 研究目的 9
第四節 名詞解釋 10
第二章 文獻探討 12
第一節 肝臟移植手術發展 12
第二節 肝臟移植手術流程 14
第三節 肝臟移植之適應症 18
第四節 肝臟移植之併發症 27
第五節 肝臟移植後醫療耗用影響因子之探討 29
第六節 肝臟移植存活率影響因子之探討 32
第三章 研究方法 39
第一節 研究設計與架構 39
第二節 研究對象與資料收集 41
第三節 研究假設 43
第四節 研究變項與操作型定義 44
第五節 資料處理與統計分析 47
第六節 研究倫理 48
第四章 結果 50
第一節 研究樣本資料描述 51
第二節 不同組別住院天數及當次住院費用之描述 57
第三節 不同組別死亡率之描述 59
第四節 比較不同組別間住院天數、醫療費用及死亡情形之影響因子分析 61
第五章 討論 67
第一節 肝臟移植性別配對之趨勢 68
第二節 不同性別配對之肝臟移植對醫療費用之差異 70
第三節 不同性別配對之肝臟移植對死亡率之差異 71
第四節 研究限制 73
第五節 結論與建議 75
參考資料 76

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