| 摘要: | 前言：大腸直腸癌一直以來都是十大癌症發生人數之冠，而大腸內視鏡檢查則是診斷的最
好工具，在執行大腸鏡檢查過程中，有 90%的大腸癌都是由大腸息肉演變而來的，從早期
發現的良性息肉再演變為癌化風險高的腺瘤，所以執行大腸鏡檢查腸道的清潔程度是相當
重要，因為不理想的清腸準備會讓息肉被糞便遮蔽影響檢查醫師的診斷率。故本研究欲探
討兩種清腸瀉藥何者清腸效果較佳及腺瘤發現率的差異性。
方法：針對臺北醫學大學附設醫院肝膽腸胃科門診住院執行大腸鏡檢查之 3,717 筆個案資
料進行分析，利用 SAS 統計軟體之卡方檢定與羅吉斯迴歸探討兩種清腸劑清腸程度及病人
基本及生理變項、息肉、腺瘤的關聯性。
結果：經本研究結果發現Bowklean Powder清腸劑清腸效果優於Klean-Prep powder清腸劑，
性別、成癮性止痛藥、高血壓與清腸程度是有顯著關係。年齡、成癮性止痛藥、清腸程度
與息肉有顯著關係。性別、年齡、便秘、TG、過去一年大腸鏡發現息肉與腺瘤有顯著關係。
在本研究中發現以清腸程度來說 Bowklean Powder 清腸劑的清腸效果優於 Klean-Prep
powder 清腸劑，但以息肉及腺瘤發現率來說 Klean-Prep powder 清腸劑比 Bowklean Powder
清腸劑更容易發現息肉或腺瘤，故進一步地探討是否與醫師操作大腸鏡的年資有關，蒐集
12 位執行內視鏡檢查醫師的工作年資平均年資為 11.75 年為切點，區分資深及資淺醫師，
進行羅吉斯回歸分析，結果無顯著關係。由於息肉→腺瘤→結腸癌演變過程，引發我探討
了兩種瀉藥在右側大腸息肉的偵測率(polyp detection rate;PDR)以及腺瘤偵測率（Adenoma
detection rate; ADR）。臨床上都會認為大腸息肉好發在左側結腸，直腸或乙狀結腸處，但
這幾年右側結腸息肉發生率有攀升，增加篩檢難度。右側結腸息肉發現人數為 2351 人，
使用 Klean-Prep powder 清腸劑有 1,023 人，發現息肉有 479 人，息肉發現率為(47%)，使
用 Bowklean Powder 清腸劑有 577 人，發現息肉有 265 人，息肉發現率為(46%)，兩種清腸
劑的息肉發現率都很接近。以總體來說，2018 年執行大腸鏡中可由兩種清腸劑中撈得總人
III
數為 3,717 人，有大腸息肉為 1,698 人，息肉發現率為 45%，以右邊大腸息肉發現人數為
1,153 人，右側息肉發現率為 68%。腺瘤偵測率（Adenoma detection rate; ADR），2018 年執
行大腸鏡總人數為 5,035 人，腺瘤共 1,562 人，腺瘤偵測率為 31%，男性 906 人，ADR 為
58%，女性 656 人，ADR 為 41%。根據研究及文獻探討，清腸程度 Bowklean Powder 清腸
劑的清腸效果佳，Klean-Prep powder 清腸劑更容易發現息肉或腺瘤，與內視鏡醫師在執行
結腸鏡檢查過程中是否執行打水抽吸清洗腸道以及是否耐心詳細審視腸道有關，文獻中提
及的水交換（WE）在檢查過程中連續注水和同時抽吸是個不錯的建議。
結論：大腸鏡檢查是篩檢結腸癌最佳的辦法，要做好完整的大腸鏡檢查，需有多方面的配
合，病人需有良好的清腸程度，內視鏡醫師需細心耐心打水抽吸糞水，清潔腸道及檢視腸
道，工欲善其事，必先利其器，有好的內視鏡管，好的主機，讓清晰的影像更能清楚地發
現病灶，以提高盲腸到達率、息肉、腺瘤偵測率，病人也不需在短期間內重複做大腸鏡檢
查。
Introduction：Colorectal cancer has always been the top ten cancer incidence and colorectal endoscopy is the best tool for diagnosis. In the process of performing colonoscopy, 90% of colorectal cancers evolve from colorectal polyps, from benign polyps found in the early stage to adenomas, with a high risk of canceration, so perform regular colonoscopy is considered important. The degree of intestinal cleanliness is very important because unsatisfactory preparations for intestinal cleansing can cause polyps to be obscured by feces and affect the
diagnosis rate of examiners. Therefore, this study intends to explore which of the two intestinal clearing laxatives has the better effect of clearing the intestines and comparing the differences in their effects on the detection rate of adenomas.
Method：Analyze the data of 3,717 cases of colonoscopy performed in the Department of Hepatobiliary and Gastroenterology of the Taipei Medical University Hospital. The Chi-square test and Logis regression of the SAS statistical software are used to explore the degree of intestinal cleansing of the two intestinal cleansing laxatives and the relationship between the patient's basic and physiological variables and polyps and adenomas.
Result：According to the results of this study, Bowklean Powder has a better bowel cleansing effect than Klean-Prep powder. There is a significant relationship between gender, addictive pain relievers, high blood pressure and the degree of bowel cleansing. Age, addictive analgesics and degree of intestinal cleansing are significantly related to polyps. In the past year, colonoscopy found that gender,age, constipation, TG have a significant relationship with polyps and adenomas. In this study, it was found that Bowklean Powder has better bowel cleansing effects than Klean-Prep powder in terms of the degree of bowel cleansing, but in terms of the discovery rate of polyps and adenomas, Klean-Prep powder bowel cleansing agent will be easier to find
polyps or adenomas than Bowklean Powder bowel cleansing agent. Collected the working experience of 12 physicians performing endoscopy, using their average working experience of 11.75 years as the cut point, divided them into senior physicians and junior physicians, and conducted Logis regression analysis, the results found that there was no significant relationship.
Due to the evolution process of polyp→adenoma→colon cancer, I tried to explore the detection rate of two laxatives in the right colorectal polyp (polyp detection rate；PDR) and the detection rate of adenoma (Adenoma detection rate; ADR). Clinically, it is believed that the colorectal polyps are more likely to occur in the left colon, rectum or sigmoid colon, but the incidence of
right colon polyps has increased in recent years, which increases the difficulty of screening. The number of polyps found in the right colon was 2,351 of which 1,023 people used Klean-Prep powder intestinal cleansing agent 479 people were found polyps, the polyp discovery rate was (47%) and 577subjects used Bowklean Powder bowel cleansing agent. 265 subjects were found to have polyps, and the polyp detection rate was 46%. The polyp detection rates of the two bowel
cleansers were very similar. Overall, the total number of patients who used two bowel cleansers for colonoscopy in 2018 was 3,717. Among them 1,698 were found to have colorectal polyps,and the polyp detection rate was 45%. There were 1,153 people who were found to have right colorectal polyps, the discovery rate of right polyps was 68%. In terms of the adenoma detection rate (ADR), the total number of people performing colonoscopy in 2018 was 5,035 of which 1,562 were found to have adenomas, and the adenoma detection rate was 31%, of which 906
were males the ADR is 58% 656 were women, and the ADR is 41%. According to research and related literature, Bowklean Powder has a better bowel cleansing effect in terms of the degree of bowel cleansing, but Klean-Prep powder bowel cleansing is easier to find polyps or adenomas.
At this point, it is believed to be related to whether the doctor performs pumping and water suction to clean the intestines during the colonoscopy and whether they patiently examine the intestines in detail. The water exchange (WE) mentioned in the literature refers to continuous water injection and simultaneous suction during the inspection process, which is a good suggestion.
Conclusion: Colonoscopy is the best way to screen for colon cancer. To do a complete colonoscopy, multiple cooperation is needed. The patient needs to have a good degree of bowel cleansing, and the endoscopist needs to be careful and patient to draw water and pump. Absorb fecal water, clean the intestines and inspect the intestines. If you want to do good things, you must first sharpen your tools, have a good endoscope tube, high-definition colonoscopes, so that
the clear image can find the lesion more clearly, all of these can improve the cecum reach rate, polyp, adenoma detection rate, and the patient does not need to repeat colonoscopy in a short period of time. |
