子宮切除手術是僅次於剖腹產之頻率最高的婦產科手術。了解不同的手術方式之品質及費用是否有差異，可在醫療資源有限的情形之下，作為病患本身及醫院管理者在做決策時之參考。
本研究係利用某區域醫院的健保申報資料檔及病歷資料，以比較子宮肌瘤大於八公分或多發性肌瘤患者進行「經腹式全子宮切除手術」與「腹腔鏡全子宮切除手術」之成效。本研究除了比較兩種方法的手術時間、住院天數、及手術出血量外，並從醫院的營運觀點，進一步比較醫院收入的差異。
本研究以個案醫院於2006年1月至2010年6月之健保申報資料及病歷資料，針對114位個案進行分析探討，其中資料採取開腹手術者有48位，而採取腹腔鏡手術者則有66位，本研究所採取的統計方法則包括t檢定及簡單迴歸分析。
分析結果顯示，在臨床效果方面，腹腔鏡手術所平均花費時間為120.45分，而開腹手術所平均花費時間則為104.35分；腹腔鏡手術的平均住院天數為4.73天，而開腹手術的平均住院天數則為5.54天；腹腔鏡手術的平均出血量為249.70cc，而開腹手術的平均出血量則為290.21cc。在醫療費用收入方面，腹腔鏡手術平均為69,268.85元，而開腹手術則平均為46,634.27元。在醫療費用方面，腹腔鏡手術平均為49,732.50元，而開腹手術則平均為42,066.27元。
依據本研究之研究發現，提出下列建議：(1)腹腔鏡手術可以安全且有效益地施行於肌瘤大於八公分或多發性肌瘤患者 (2)醫院應該發展醫療處置標準化，以避免醫療品質成為成本控制下的犧牲品。另一方面，也可藉由醫療處置的標準化，來檢視醫療流程是否有浪費的情形發生。

關鍵字：子宮肌瘤、子宮切除、經腹式、腹腔鏡、手術成效。

Hysterectomy is the second highest frequency of gynecologic surgery. With limited medical resources, understanding of qualities and expenses of different types of surgery can be used as a reference for patients and hospital administrators in making related decisions.
Therefore, the purpose of this study is to compare the outcomes between “Total Abdominal Hysterectomy” and “Laparoscopic Hysterectomy”. Data sources are the health insurance report data files and charts of a regional teaching hospital. There were 114 cases between January 2006 and June 2010 at the sample hospital. Operating time, length of stay, and intra-operative blood loss between both types of hysterectomy are analyzed and compared by using t-test. Linear regression analysis is then used to examine the predictive factors that impact the outcomes of both types of surgery.
The results indicate that, in terms of clinical results, laparoscopic hysterectomy takes 120.45 minutes on average, and total abdominal hysterectomy 104.35 minutes; laparoscopic hysterectomy requires an average of 4.73 days of hospital stay, and total abdominal hysterectomy 5.54 days; and finally, laparoscopic hysterectomy causes an average of intra-operative blood loss of 249.70cc, and total abdominal hysterectomy 290.21cc, laparoscopic hysterectomy costs an average of NT$69,268.85, and total abdominal hysterectomy NT$46,634.88. In regard to hospitalization costs, laparoscopic hysterectomy costs an average of NT$49,732.50, and total abdominal hysterectomy costs NT$42,066.27.
Based on findings of this study, the following suggestions are proposed: (1) Laparoscopic hysterectomy can be safely and effectively used for patients with large uterine myoma or multiple myoma. (2)Hospitals should develop standardized medical treatment procedures; therefore, cost control would not be at the expense of the quality of care. Furthermore, standardization of medical treatment can be used to pinpoint whether there is any waste in the medical treatment process.

Keywords: uterine myoma, hysterectomy, total abdominal hysterectomy, laparoscopic hysterectomy, outcome.

目錄 頁碼
論文審定書 i
致謝 ii
中文摘要 iii
英文摘要 iv
目錄 vi
表目錄 vii
圖目錄 viii
第一章 緒論 1
第一節 研究背景及動機 1
第二節 研究目的 4
第二章 文獻探討 5
第一節 子宮肌瘤概述 5
第二節 國內子宮切除概況 9
第三節 子宮切除概述 11
第四節 子宮切除之醫療品質指標 14
第五節 影響全子宮切除手術成效之相關因素 18
第三章 研究方法 23
第一節 研究流程及架構 23
第二節 研究變項的操作型定義 25
第三節 研究假說 28
第四節 研究對象 29
第五節 研究設計及資料來源 30
第六節 資料處理及分析方法 31
第四章 研究結果 32
第一節 描述性統計的分析結果 32
第二節 推論性統計的分析結果 39
第五章 結果討論與建議 52
第一節 結論 52
第二節 手術成效之差異 53
第三節 全子宮切除影響因素 56
第四節 研究貢獻 57
第五節 研究限制及建議 58
參考文獻 60

表目錄 頁碼
表 2-1子宮肌瘤診斷執行手術比率－年齡別 10
表 2-2醫療費用影響因素 17
表 2-3全子宮切除手術成效之相關研究 21
表 3-1各研究變項的操作型定義 27
表 3-2子宮切除手術病患的相關資料來源 30
表 4-1腹腔鏡及開腹式全子宮切除手術個案的人口學基本資料 32
表 4-2子宮重量等變項的平均統計結果 33
表 4-3腹腔鏡及開腹式全子宮切除手術成效及醫療費用的平均統計結果 34
表 4-4腹腔鏡及開腹式全子宮切除手術之成效及醫療利用情形的統計分析結果 36
表 4-5腹腔鏡及開腹式手術方式對醫院費用收入的統計分析結果 38
表 4-6腹腔鏡手術及開腹式手術方式對醫院費用收入的統計分析結果 40
表 4-7子宮重量對於子宮切除之相關性 41
表 4-8肌瘤大小對於子宮切除成效之相關性 42
表 4-9肌瘤數量對於子宮切除成效之相關性 43
表 4-10醫師年資對於子宮切除成效之相關性 43



圖目錄 頁碼
圖3-1 研究流程圖 23
圖3-2 研究架構圖 24
圖4-1 子宮重量與住院天數散佈圖 44
圖4-2 子宮重量與手術出血量散佈圖 45
圖4-3 子宮重量與醫院費用收入散佈圖 46
圖4-4 肌瘤大小與住院天數散佈圖 47
圖4-5 肌瘤大小與手術出血量散佈圖 48
圖4-6 肌瘤大小與醫療費用散佈圖 49
圖4-7 肌瘤大小與醫院費用收入散佈圖 50
圖4-8 肌瘤數量與醫院費用收入散佈圖 51

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