因罹患大腸直腸疾病或外傷而需要接受腸造口手術者日益增多，大多數的病患皆希望腸造口可以盡快關閉，以減少造口對各方面的負擔。但由於腸造口常伴隨許多傷口相關等併發症，從腸造口到關閉之間的等待時間，從古至今，莫衷一是。
本研究期利用國家衛生研究院「全民健康保險學術研究資料庫(National Health Insurance Research Database)」，選取2007年1月1日~2008年12月31日止之資料，分析影響關閉時間點及術後品質之因素，以預測適當之腸造口關閉時間點，供醫師執行腸造口關閉術時，選擇時間點之參考。
研究結果顯示，463位腸造口關閉術病患之平均年齡為65.94歲；男女比約為1.66。70.19%之主診斷為結腸造口之照料，29.81%為迴腸造口之照料；平均關閉時間點為腸造口後的156.73天；平均住院日數為10.81日；住院總醫療費用平均為57,698.06元；住院期間共有1位為死亡個案或病危自動出院；出院後有35人於30日內再住院。在α=0.05下，主要影響關閉時間點之因素為共病程度、疾病別；而影響醫療品質之因素為關閉時間點、共病程度、病患年齡、病患性別、醫院權屬別及醫師服務量。
透過本研究，適當的關閉時間點應隨病患特質、醫師特質而不同，醫師可藉由分層分析圖預測，選擇對於病人較為有利的關閉時間點，安排手術排程所需之人力物力，減少延後最佳關閉時機的情形發生，如此可以使院內資源達到較好的利用進而提升醫療品質。

Patients of stoma caused by the colorectal disease or trauma are increasing and most of the patients are keen to have their stoma closed as early as possible to lower the burdens in their life. However, stoma often associated with complications such as wound. The interval between constructing and closing of stoma is still controversial.
This study will figure out a way to predict an appropriate timing of stoma closure to get better outcome by using NHI database, from January 1, 2007 to December 31, 2008, in Taiwan.
In 463 stoma closure patients, mean age: 65.94 years, ratio of male to female: 1.66, 70.19% Colostomy, 29.81% Ileostomy, mean timing: 156.73 days, mean length of stay: 10.81 days, mean fees: 57,698.06 TWD, only one death in hospital, 35 readmission within 30 days after discharged; with α = 0.05 level, the timing is significant in comorbidity, primary diagnosis; the outcomes are associated with the timing of stoma closure, comorbidity, patients’ age and gender, hospital ownership and physician annual volume.
Through this study, a perfect timing of stoma closure should be determined by the characteristics of patient and physician. Physicians could predict the timing through the stratified analysis and well organize the resource of hospital to improve the quality of medical care.

論文審定書 I
誌謝 II
中文摘要 III
英文摘要 IV
目錄 V
表目錄 VII
圖目錄 VIII
第一章 緒論 1
第一節 研究緣起 1
第二節 研究目的 2
第二章 文獻探討 3
第一節 腸造口與腸造口關閉術介紹 3
第二節 腸造口關閉術之術後品質指標 6
第三節 關閉時間點與術後品質之影響因素 8
第四節 文獻探討總結 20
第三章 研究方法 21
第一節 研究架構 22
第二節 資料處理流程 23
第三節 研究變項定義 25
第四章 資料分析 29
第一節 腸造口關閉術之病患基本特質 30
第二節 腸造口關閉術後醫療品質概況 32
第三節 關閉時間點、醫療品質之影響因素 33
第四節 關閉時間點、醫療品質之交互作用 39
第五節 關閉時間點、醫療品質之分層百分比 64
第五章 結果討論與建議 67
第一節 研究結果討論 67
第二節 研究限制 70
第三節 結論 71
第四節 建議 74
參考文獻 76

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