结直肠癌筛查对结直肠肿瘤早期诊断的意义  

Significance of Colorectal Cancer Screening for Early Diagnosis of Colorectal Neoplasms

作　　者：孙颖[1] 马瑾[1] 顾玮[1] 胡梅洁[1] 郑雄[1] SUN Ying;MA Jin;GU Wei;HU Meijie;ZHENG Xiong(Department of Gastroenterology,Luwan Branch,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai,200020)

机构地区：[1]上海交通大学医学院附属瑞金医院卢湾分院消化内科,200020

出　　处：《胃肠病学》2022年第3期173-176,共4页Chinese Journal of Gastroenterology

基　　金：上海市黄浦区科研项目(HKW201504)。

摘　　要：背景:我国结直肠癌(CRC)发病率和死亡率呈上升趋势,发病年龄趋于年轻化。目的:分析CRC筛查初筛阳性人群的结肠镜检查结果,探讨高危问卷联合粪便隐血试验的CRC筛查模式对于结直肠肿瘤早期诊断的意义。方法:连续纳入2013年5月—2019年10月参与上海市黄浦区社区CRC筛查,因初筛结果阳性至瑞金医院卢湾分院接受结肠镜检查的高危个体,内镜检查发现病变者取活检或摘除送病理检查。同期因排便习惯改变行结肠镜检查的患者作为对照组。分析两组结直肠肿瘤检出情况以及筛查阳性组的病变特征。结果:共1329例初筛阳性者纳入研究,结肠镜检查病变总体检出率为63.3%,CRC、息肉和腺瘤性息肉检出率分别为2.6%(34例)、60.7%(807例)和35.2%(468例),均显著高于对照组(n=22438)的43.6%、1.8%、41.5%和21.6%(P均<0.05)。筛查阳性组病变检出率男性显著高于女性(73.7%对54.2%,P<0.05),且随年龄增长呈增高趋势(P<0.05)。CRC主要分布于60~79岁年龄组,无性别分布差异,病变直径均≥1 cm;发生异型增生的腺瘤直径亦多≥1 cm,无异型增生的腺瘤以及增生性和炎性息肉直径则多<1 cm。结论:我国现阶段实行的社区CRC筛查模式可有效提高CRC及其癌前病变检出率。Background:The incidence rate and mortality of colorectal cancer(CRC)in China are increasing,and the age of onset is tending to be younger.Aims:To analyze the results of colonoscopy in patients positive for CRC screening,and to explore the significance of a CRC screening protocol that combines risk assessment questionnaire with fecal occult blood test(FOBT)in early diagnosis of colorectal neoplasms.Methods:Individuals who were positive for the first stage of screening(questionnaire+FOBT)in a community CRC screening program in Shanghai Huangpu District from May 2013 to October 2019 and then received the second stage of screening(colonoscopy)in Ruijin Hospital Luwan Branch were enrolled consecutively.Biopsy or polypectomy specimens were taken for pathological examination if any lesions were found endoscopically.Patients who underwent colonoscopy due to changes in bowel habits in the same period were served as controls.The detection rates of colorectal neoplasms in these two groups and the disease characteristics in the screening positive group were analyzed.Results:The screening positive group included 1329 residents positive for the first stage of screening.The overall detection rate of colorectal lesions was 63.3%,and the detection rates of CRC,colorectal polyps and adenomatous polyps were 2.6%(34 cases),60.7%(807 cases)and 35.2%(468 cases),respectively.While in control group(n=22438),the rates were 43.6%,1.8%,41.5%,and 21.6%,respectively,all were significantly lower than those in screening positive group(all P<0.05).In screening positive group,the overall detection rate of colorectal lesions was higher in male than in female(73.7%vs.54.2%,P<0.05)and increased with aging(P<0.05).Most of the CRC cases were in 60⁃79 years old age group with no gender difference.All CRC and most of the adenomas with dysplasia were greater than or equal to 1 cm in diameter,while most of the adenomas without dysplasia,hyperplastic polyps and inflammatory polyps were less than 1 cm in diameter.Conclusions:The community CRC screening

关 键 词：结直肠癌筛查 结肠镜检查 早期诊断 结直肠肿瘤 肠息肉 腺瘤 

分 类 号：R735.34[医药卫生—肿瘤]