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| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 蕭妃秀 | zh_TW |
| dc.contributor.advisor | Fei-Hsiu Hsiao | en |
| dc.contributor.author | 吳政廷 | zh_TW |
| dc.contributor.author | Cheng-Tien Wu | en |
| dc.date.accessioned | 2025-09-17T16:31:21Z | - |
| dc.date.available | 2025-09-18 | - |
| dc.date.copyright | 2025-09-17 | - |
| dc.date.issued | 2025 | - |
| dc.date.submitted | 2025-08-06 | - |
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Technology in Cancer Research & Treatment, 21, 15330338221118983. | - |
| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/99734 | - |
| dc.description.abstract | 研究背景：吻合處滲漏（Anastomotic leakage, AL）是大腸直腸癌手術後常見且嚴重的併發症，特別是在高齡病人中，發生後可能導致感染、延長住院、再手術，甚至死亡，對病人預後與醫療資源皆構成重大挑戰。
研究目的：本研究旨在探討大腸直腸癌高齡病人術後發生吻合處滲漏之現況和危險因子，以提供臨床照護及風險評估之依據。 研究方法：本研究採回溯性配對病歷對照研究設計，分析 2018 年至 2022 年間於臺大醫院大腸直腸外科接受手術治療之 65 歲以上大腸直腸癌病人病歷資料，依吻合處是否發生滲漏區分為病例組（n=26）與對照組 （n=440），並採 1:4 頻率配對（條件為性別、年齡層、術式）控制潛在影響因子。研究資料包含病人基本資料、臨床變項與術後狀況，進行單變項及多變項條件式邏輯迴歸分析，並以 ROC 曲線檢視模型預測能力。 研究結果：本研究納入共 466 位個案，吻合處滲漏發生率為 5.6%，再分成配對後病例組（n=24）和配對後對照組（n=96）。多變項條件式邏輯迴歸分析結果顯示，嚼食檳榔（OR=6.04, p=0.031）、傳統開腹手術（OR=6.10,p=0.008）、輸血（OR=3.54， p=0.028）及術後腸阻塞（aOR=4.18, p=0.045）為吻合處滲漏之顯著危險因子。ROC 曲線分析顯示模型具良好區辨能力（AUC=0.767, p<0.001）。 結論與建議：本研究結果顯示，除了手術相關的因素外，高齡大腸直腸癌病人若有嚼食檳榔，發生吻合處滲漏的風險顯著增加，建議臨床可針對高風險族群（如檳榔使用者、需輸血或有術後腸阻塞傾向者）加強評估與術後照護，並思考是否能採用微創手術以降低併發症發生率。 | zh_TW |
| dc.description.abstract | Background: Anastomotic leakage (AL) is a common and severe postoperative
complication following colorectal cancer surgery, particularly among elderly patients. AL may lead to infection, prolonged hospitalization, reoperation, or even mortality,posing significant challenges to clinical outcomes and healthcare resources. Purpose: This study aimed to identify the risk factors associated with anastomotic leakage in elderly patients undergoing colorectal cancer surgery, to support clinical risk assessment and patient care strategies. Methods: A retrospective case-control study was conducted using medical records of patients aged ≥65 years who underwent colorectal cancer surgery between 2018 and 2022 at the colorectal surgery department of National Taiwan University Hospital. Patients were categorized into the case group (with AL, n=26) and the control group(without AL, n=440). Frequency matching (1:4) was performed based on sex, age group, and surgical approach. Conditional univariate and multivariate logistic regression analyses were used to identify potential risk factors, and the predictive performance of the model was evaluated using ROC curve analysis. Results: A total of 466 patients were included in this study, with an anastomotic leakage (AL) incidence of 5.6%. After frequency matching, 24 patients were assigned to the case group and 96 to the control group. Conditional multivariate logistic regression analysis identified areca nut chewing (OR = 6.04, p = 0.031), open surgery (OR = 6.10, p = 0.008), blood transfusion (OR = 3.54, p = 0.028), and postoperative ileus (OR = 4.18, p = 0.045) as significant risk factors for AL. Receiver operating characteristic (ROC) curve analysis demonstrated good discriminatory ability of the model (AUC =0.767, p < 0.001). Conclusions: Elderly colorectal cancer patients with specific clinical characteristics—such as areca nut chewing, intraoperative transfusion, or postoperative ileus—are at higher risk of anastomotic leakage. Clinical practitioners should consider enhanced perioperative assessment and postoperative care for high-risk groups, and where feasible, favor minimally invasive surgical approaches to reduce the likelihood of complications. | en |
| dc.description.provenance | Submitted by admin ntu (admin@lib.ntu.edu.tw) on 2025-09-17T16:31:21Z No. of bitstreams: 0 | en |
| dc.description.provenance | Made available in DSpace on 2025-09-17T16:31:21Z (GMT). No. of bitstreams: 0 | en |
| dc.description.tableofcontents | 誌謝 i
中文摘要 ii 英文摘要(Abstract) iii 第一章 前言 1 第二節 研究目的 3 第二章 文獻回顧 3 第一節 大腸直腸癌的篩檢、診斷、分期以及治療 3 大腸直腸癌的篩檢與診斷 3 大腸直腸癌的分期 5 大腸直腸癌的治療 5 第二節 腸道吻合處滲漏合併症 9 第三節 腸道吻合處滲漏合併症之危險因子 12 人口學 13 健康狀況 13 癌症相關因子 16 手術相關因子 17 第三章 研究方法 20 第一節 研究設計 20 第二節 研究架構 20 第三節 研究場所及對象 23 第四節 納入及排除條件 24 納入條件 24 排除條件 24 第五節 研究工具 24 第六節 統計分析 27 第七節 研究倫理考量 27 第四章 研究結果 28 第一節 配對人口學和吻合處滲漏現況 28 第二節 影響吻合處滲漏的相關因子 29 第三節 影響吻合處滲漏的主要危險因子 33 迴歸模型之 ROC 與 AUC 35 第五章 討論 37 第一節 高齡病人吻合處滲漏現況 37 第二節 影響吻合處滲漏的主要危險因子探討 38 嚼食檳榔 39 手術進行方式 40 輸血 40 術後腸阻塞 40 與其他文獻比較 41 第三節 研究限制 42 第六章 結論與建議 44 第一節 結論 44 第二節 臨床應用與建議 44 第七章 參考資料 45 | - |
| dc.language.iso | zh_TW | - |
| dc.subject | 高齡 | zh_TW |
| dc.subject | 吻合處滲漏 | zh_TW |
| dc.subject | 病例對照研究 | zh_TW |
| dc.subject | 危險因子 | zh_TW |
| dc.subject | 大腸直腸癌 | zh_TW |
| dc.subject | case-control study | en |
| dc.subject | risk factors | en |
| dc.subject | colorectal cancer | en |
| dc.subject | elderly | en |
| dc.subject | Anastomotic leakage | en |
| dc.title | 大腸直腸癌高齡病人術後發生吻合處滲漏之危險因子探討：回溯性配對病歷對照研究 | zh_TW |
| dc.title | Risk Factors for Anastomotic Leakage in Elderly Patients After Colorectal Surgery: Retrospective Matched Case-control Study | en |
| dc.type | Thesis | - |
| dc.date.schoolyear | 113-2 | - |
| dc.description.degree | 碩士 | - |
| dc.contributor.oralexamcommittee | 梁金銅;張晉豪 | zh_TW |
| dc.contributor.oralexamcommittee | Jin-Tung Liang;Chin-Hao Chang | en |
| dc.subject.keyword | 吻合處滲漏,高齡,大腸直腸癌,危險因子,病例對照研究, | zh_TW |
| dc.subject.keyword | Anastomotic leakage,elderly,colorectal cancer,risk factors,case-control study, | en |
| dc.relation.page | 51 | - |
| dc.identifier.doi | 10.6342/NTU202504084 | - |
| dc.rights.note | 同意授權(全球公開) | - |
| dc.date.accepted | 2025-08-07 | - |
| dc.contributor.author-college | 醫學院 | - |
| dc.contributor.author-dept | 護理學研究所 | - |
| dc.date.embargo-lift | 2025-09-18 | - |
| 顯示於系所單位： | 護理學系所 | |
文件中的檔案：
| 檔案 | 大小 | 格式 | |
|---|---|---|---|
| ntu-113-2.pdf | 2.13 MB | Adobe PDF | 檢視/開啟 |
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