詹明修魏正宗Ming-Xiu ZhanCheng-Chung Wei林成行Cherng-Harng Lim醫學研究所碩士班2026-10-292025-07-2420252025-06-26https://handle.ncl.edu.tw/11296/qnr9hthttps://scholars.csmu.edu.tw/handle/123456789/36741中文摘要研究背景 : 隨著大腸癌發生率攀升、人口老化加劇，大腸鏡檢查需求大幅增加，尤其偏鄉地區醫療資源不足與人力短缺問題更顯突出。然而，目前缺乏注水式與傳統大腸鏡在效率與適用性上的比較研究，因此亟需探討注水式檢查法能否減輕人力負荷並提升高風險族群的檢查可近性。研究目的 : 本研究旨在比較「注水式大腸鏡」與「傳統大腸鏡」於減痛患者之執行效率，評估指標包括: 檢查時間等指標、鎮靜止痛藥物劑量、息肉檢出率、疼痛分數及併發症，並探討影響大腸鏡檢查成效之關鍵因素。另外也進一步分析不同檢查方法與操作順序之交互作用，以提供臨床應用之參考依據。研究方法及資料 : 本研究採用回溯性世代研究設計，納入2018至2019年間兩家偏鄉地區醫院接受大腸鏡檢查之患者資料，共362例符合納入條件，其中203例接受注水式大腸鏡、159例接受傳統大腸鏡，另158例接受雙鏡檢查。所有檢查均由同一位專科醫師執行以確保一致性，並記錄基本資料、藥物劑量、輔助方法及檢查順序等參數。統計分析採用描述性統計與推論性統計，包括卡方檢定、t檢定、變異數分析、廣義線性模型及多元邏輯斯迴歸分析，並以SAS 9.4軟體進行數據處理。研究結果 : 研究主要結果顯示，注水式大腸鏡檢查時間比傳統大腸鏡短41% ( 5分鐘vs. 8.5分鐘，P<0.001)，平均可降低約71.4%（70.6%-72.2%）的操作時間延長風險。在次要分析結果指出，注水式大腸鏡在多項指標上顯著優於傳統大腸鏡，如: 疼痛評分降低67% (1 vs. 3分，P<0.001及鎮靜止痛藥物用量分別減少44% ( Meperidine， 0.40 vs. 0.7 mg/kg， P<0.001 ) 及43% ( Dormicum中位數，0.04 vs. 0.07 mg/kg，P<0.001 )，且本研究發現疼痛分數與藥物劑量及檢查時間呈正相關，顯示疼痛管理為影響檢查效率之關鍵因素。在特定族群中注水式大腸鏡優勢更顯著，如女性、高齡及具腹部手術史能有效提升檢查耐受性如大腸檢查耗時減少41.4% - 49.9%及疼痛評分降低50.9% - 69.5%。在雙鏡檢查中，若採用「胃鏡優先」的檢查順序，大腸檢查效率提升至41% (5.0 vs. 8.5分鐘，P<0.001 )；後續胃鏡疼痛評分降低43% (2 vs. 3.5分，P<0.002 )。結論與建議 : 注水式大腸鏡在多項指標上均優於傳統大腸鏡，特別是在縮短檢查時間及改善患者舒適度方面表現突出，其中雙鏡檢的“胃鏡-注水式大腸鏡”組合之綜合效益最為顯著。雖然注水式大腸鏡在不同檢查情境下均具臨床優勢，但對於部分特定患者群體，其效能仍有局限性，尤其是在低體重或清腸準備不足者改善效果有限。AbstractBackground: With rising colorectal cancer incidence and population aging, colonoscopy demand grows rapidly, especially in underserved rural areas. Current evidence lacks direct comparison between water immersion and traditional colonoscopy regarding efficacy and suitability for high-risk populations (elderly, rural residents) and procedural efficiency. This study aims to evaluate water immersion's advantages in these clinical scenarios.Objective: This study aimed to compare the procedural efficiency between water-aided colonoscopy (WAC) and traditional colonoscopy (TC) in minimal sedated patients. Key evaluation metrics include: procedure time, pain scores, sedative/analgesic dosage, polyp detection rate, and complication rates.. Additionally, it investigated key factors influencing colonoscopy outcomes and analyzed the interaction between different examination methods and procedural sequences to provide evidence for clinical decision-making.Methods and Materials: This retrospective cohort study analyzed data from patients who underwent colonoscopy at two rural hospitals between 2018 and 2019. A total of 362 eligible patients were included: 203 underwent WAC, 159 received TC, and 158 underwent dual endoscopy (gastroduodenoscopy (EGD) and colonoscopy). All procedures were performed by a single specialist to ensure consistency. Data collected included baseline characteristics, medication dosages, adjunct techniques, and procedural sequences. Statistical analysis employed descriptive and inferential methods, including chi-square tests, t-tests, ANOA, generalized linear models, and multivariate logistic regression, processed using SAS 9.4.Results : The study met its primary endpoint, demonstrating a 41% reduction in median procedure of time in WAC compared to conventional methods (5.0 vs 8.5 minutes, P<0.001), and reduced the risk of prolonged procedure time by approximately 71.4% (range: 70.6%-72.2%)。Meanwhile, it also achieving its secondary endpoints with a 67% reduction in pain scores (1 vs 3, P<0.001) and 43-44% decreases in sedative requirements (Meperidine: 0.40 vs 0.71mg/kg; Dormicum: 0.04 vs 0.07mg/kg, both P<0.001). The benefits were particularly pronounced in specific subgroups (women, elderly patients and those with abdominal surgery history) collectively exhibiting 41.4%-49.9% time reduction and 50.9-69.5% pain improvement. In dual-endoscopy procedures, the esophagogastroduodenoscopyn (EGD) -first approach combined with WAC enhanced colonoscopy efficiency by 41% (5 vs 8.5 minutes, P<0.001) while reducing subsequent EGD discomfort by 43% (2 vs 3.5, P=0.002).Conclusion and Suggestion: WAC outperformed traditional colonoscopy in both patient comfort and procedural efficiency across various clinical scenarios, with the "EGD-first + WAC" sequence yielding optimal outcomes. Despite WAC demonstrated broad clinical advantages, its efficacy remained limited in specific subgroups such as low-body weight patients or inadequate bowel preparation cases.大腸鏡注水式傳統大腸鏡減痛檢查ColonoscopyWater-aidedTraditional ColonoscopySedationthesis