胃癌群体性筛查联合机会性筛查的初步研究  

A preliminary study on the combination of group screening and opportunistic screening for gastric cancer

作　　者：褚衍六[1] 李冰 宋向锋 赵钦府 王萍[1] 刘奉 丛明 刘琳 林霖 李田[1] 徐晓燕[1] 张亚琳 姜坤[1] 苏秀峰 高孝忠 令狐恩强[4] Chu Yanliu;Li Bing;Song Xiangfeng;Zhao Qinfu;Wang Ping;Liu Feng;Cong Ming;Liu Lin;Lin Lin;Li Tian;Xu Xiaoyan;Zhang Yalin;Jiang Kun;Su Xiufeng;Gao Xiaozhong;Linghu Enqiang(Department of Gastroenterology,Weihai Municipal Hospital,Shandong University,Weihai 264200,China;Department of Gastroenterology,Weihai Wendeng District Traditional Chinese and Western Medicine Hospital,Weihai 264400,China;Department of Gastroenterology,Ru Shan Peoples Hospital,Weihai 264500,China;Department of Gastroenterology,The First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]山东大学附属威海市立医院消化内科,威海264200 [2]威海市文登区中西医结合医院消化内科,威海264400 [3]乳山市人民医院消化内科,威海264500 [4]解放军总医院第一医学中心消化内科医学部,北京100853

出　　处：《中华消化内镜杂志》2023年第11期886-891,共6页Chinese Journal of Digestive Endoscopy

基　　金：威海市农村居民胃癌筛查项目(威卫计疾控[2017]24号)。

摘　　要：目的探讨胃癌群体性筛查联合机会性筛查的新模式对胃癌诊治的价值。方法利用群体性筛查联合机会性筛查进行胃癌普查。(1)群体性筛查:采用整群抽样法,2017年7月—2020年12月对威海市农村居民中的高危人群(年龄40~<70岁)进行内镜普查,必要时进行活检并送组织病理学检查。主要采集指标:进展期胃癌、早期胃癌、高级别上皮内瘤变(high grade intraepithelial neoplasia,HGIN)的检出率。(2)机会性筛查:同步观察2017年7月—2020年12月威海市两家区县级医院机会性筛查早期胃癌检出率的变化。结果(1)群体性筛查:2017年7月—2020年12月,首批完成8000例胃癌筛查。进展期胃癌、早期胃癌、HGIN分别检出36、28、62例,胃癌总例数为64例,胃癌检出率、早期胃癌检出占比分别为0.80%(64/8000)、43.75%(28/64)。早期胃癌+HGIN患者接受内镜黏膜下剥离术治疗者占77.78%(70/90),治愈性切除率100.00%(70/70)。(2)机会性筛查:2017年7月—2020年12月,文登区中西医结合医院机会性筛查中每年早期胃癌检出占比分别16.67%(1/6)、20.00%(3/15)、23.53%(4/17)、33.33%(6/18),乳山市人民医院机会性筛查中每年早期胃癌检出占比分别14.74%(14/95)、23.80%(60/252)、25.49%(65/255)、24.04%(50/208)。威海市医院机会性筛查早期胃癌检出占比呈逐年上升趋势。结论在胃癌高发区,一定规模的群体性筛查可进一步带动更广泛的机会性筛查,从而提高早期胃癌检出率,该胃癌诊治新模式值得推广。Objective To evaluate the new model of group screening combined with opportunistic screening for the diagnosis and treatment of gastric cancer.Methods Group screening combined with opportunistic screening was used for gastric cancer screening.(1)Group screening.Cluster sampling was used to screen gastric cancer by endoscopy in high-risk population(aged 40-<70 years)of rural residents in Weihai from July 2017 to December 2020,and biopsy was obtained for histopathology if necessary.Main collection parameters included the detection rate of advanced gastric cancer,early gastric cancer and high-grade intraepithelial neoplasia(HGIN).(2)Opportunistic screening.The changes of the detection rates of early gastric cancer in opportunistic screening in 2 hospitals in Weihai area were observed during the same period of time.Results(1)In group screening,from July 2017 to December 2020,the first batch of 8000 cases of gastric cancer screening were completed.The cases of advanced gastric cancer,early gastric cancer and HGIN were 36,28,and 62,respectively.The detection rates of gastric cancer and early gastric cancer were 0.80%(64/8000)and 43.75%(28/64),respectively.The proportion of early gastric cancer+HGIN who received endoscopic submucosal dissection(ESD)was 77.78%(70/90),and the rate of curative resection was 100.00%(70/70).(2)Opportunistic screening:from July 2017 to December 2020,the annual early gastric cancer detection rates in opportunistic screening in Wendeng District Traditional Chinese and Western Medicine Hospital were 16.67%(1/6),20.00%(3/15),23.53%(4/17),and 33.33%(6/18)in the consecutive 4 years,respectively.The annual detection rates of early gastric cancer in opportunistic screening in Ru Shan Peoples Hospital were 14.74%(14/95),23.80%(60/252),25.49%(65/255),and 24.04%(50/208),respectively.The detection rates of opportunistic screening for early gastric cancer in hospitals in Weihai city increased year by year.Conclusion In areas with high incidence of gastric cancer,a certain scale of group screening can lead

关 键 词：胃肿瘤 诊断 模式 筛查 早期胃癌 胃镜 超级微创手术 

分 类 号：R735.2[医药卫生—肿瘤]