| 摘要: | 衛生福利部民國106年統計資料顯示肝癌高居十大癌症死因之第二位，肝癌死亡率極高，是我們需要關注的疾病。目前肝癌病人的臨床照護以接受傳統肝動脈栓塞療法及載藥微球肝動脈栓塞療法兩種治療方式為主。依據過去研究報告顯示載藥微球肝動脈栓塞術比傳統肝動脈栓塞療法有較多優點及安全性，但載藥微球肝動脈栓塞術健保不給付，需要額外自費3~5萬不等金額，因此期望藉由研究證實其治療成效。本研究擬藉由病例對照分析探討接受傳統肝動脈栓塞療法與載藥微球肝動脈栓塞療法病人的合併症發生狀況、平均住院天數、是否再次住院、再次住院平均間隔天數是否有顯著差異。
本研究採用回溯性病歷對照分析研究設計，選取南部某醫學中心民國105至106年期間，因肝癌住院並首次接受傳統肝動脈栓塞療法(對照組)及載藥微球肝動脈栓塞治療法(實驗組)之病人為研究對象。藉由電子病歷資料收集首次住院天數，接受肝動脈栓塞療法後合併症發生狀況，是否再次住院，及再次住院接受肝癌相關治療之間隔天數等相關資料，進行比較分析。
研究結果顯示對照組與實驗組之研究樣本在年齡、性別與疾病特性如腫瘤大小、腫瘤數目、B型肝炎及C型肝炎方面無統計顯著差異，在疾病Child-Pugh分級(p=0.042)具有統計顯著差異，在CLIP分級及BCLC分級則無統計上差異。病人的六項常見合併症中，包含腹痛、發燒、寒顫、噁心、嘔吐與食慾不振，載藥微球肝動脈栓塞療法只有腹痛(p=0.029)的發生比率顯著較低。二組病人在平均住院天數、是否再次住院狀況及再次住院平均間隔天數則無統計上的顯著差異。分析結果顯示載藥微球肝動脈栓塞療法病人相較於傳統肝動脈栓塞療法病人之再次住院的風險比為0.89，有較低的再次入院風險，但未達統計顯著水準(p = 0.507)。
本研究結果發現傳統肝動脈栓塞療法與載藥微球肝動脈栓塞療法之成效，除了腹痛合併症的發生狀況有顯著差異外，在其他合併症發病狀況、平均住院天數、是否再次住院及再次住院間隔天數，均無顯著統計差異。此研究結果可以提供肝癌醫療照護團隊在病情說明與醫療措施之建議參考，也可提供病人及家屬在選擇治療決策的考量。
According to statistics from the Ministry of Health and Welfare in 2017, liver cancer ranks second among the top ten cancer deaths. The mortality rate of liver cancer is extremely high and we need to pay attention to this disease. At present, the clinical care of patients with liver cancer is mainly treated by traditional hepatic artery embolization therapy and drug-loaded microsphere hepatic artery embolization therapy. According to past research reports, hepatic artery embolization with drug-loaded microspheres has more advantages and safety than traditional hepatic artery embolization therapy, but the cost of drug-loaded microsphere hepatic artery embolization therapy is not covered by national health insurance, and it requires an additional self-expenditure from 30,000 to 50,000 dollars. Effectiveness of drug-loaded microsphere hepatic artery embolization therapy is expected to be confirmed by more researches. Therefore, this study intends to investigate differences in the incidence of comorbidities, the average length of hospital stay, numbers of re-hospitalization, and the average days of re-hospitalization between patients with traditional hepatic artery embolization therapy and with drug-loaded microsphere hepatic artery embolization therapy.
Data collected from retrospective medical records in a medical center from 2016 to 2017 was analyzed. Subjects hospitalized with liver cancers and the first time received traditional hepatic artery embolization therapy (a control group) and drug-loaded microsphere hepatic artery embolization treatment (an experimental group) were recruited in this study. Differences in the incidence of comorbidities, the average length of hospital stay, numbers of re-hospitalization, and the average days of re-hospitalization between these two groups were analyzed by properly statistical methods.
Results of this study showed that there were no statistically significant differences in age, gender, and disease characteristics such as the tumor size, numbers of tumor, hepatitis B, and hepatitis C between control and experimental groups. A significant difference was found in the Child-Pugh classification (p=0.042), but no statistical differences were found in CLIP grading and BCLC grading. Six common comorbidities including abdominal pain, fever, chills, nausea, vomiting, and loss of appetite, only the incidence of abdominal pain was significantly lower in the drug-loaded microsphere hepatic artery embolization therapy(p=0.029). No statistically significant differences in the incidence of comorbidities, the average length of hospital stay, numbers of re-hospitalization, and the average days of re-hospitalization between these two groups. Although results of regression analysis showed that the re-hospitalization hazard ratio of the drug-loaded microsphere hepatic artery embolization therapy compared to the control group was 0.89, it was not statistically significant.
Effectiveness of drug-loaded microsphere hepatic artery embolization therapy was not significant in this study, except the occurrence of abdominal pain comorbidities. It can provide a reference for the liver cancer medical care team to make professional treatment plan, as well as for patients and their families to make decisions in the choice of medical treatments. |
