上海市嘉定地区3509例结肠镜筛查中无症状肿瘤性疾病比对研究

A retrospective study of 3 509 cases undergoing colonoscopy in Jiading District of Shanghai

目的：探讨症状性及无症状人群中结肠直肠肿瘤性疾病的分布规律,以期更好地指导今后的临床及科研工作。方法：收集2013年1月至2014年2月间上海交通大学医学院附属瑞金医院北院就诊的3 509例结肠镜检查人群基本信息,包括性别、年龄、发病时的症状、结肠镜检查结果及相关病理检查结果。将受检者分为症状筛查组（如腹痛、腹泻、黏液便、腹胀等）和无症状筛查组（粪便隐血试验阳性）,进行统计学分析以期找出其中的相同及差异。结果：3 509例结肠镜受检者的平均年龄为（55±13）岁,按症状分为症状筛查组和无症状筛查组（639例）。3 509例受检者的结肠直肠息肉检出率为34.4%,结肠直肠癌检出率为2.6%。男女性别间的病灶检出率无差异,而60~69岁受检者的恶性肿瘤占所有检出肿瘤构成比为44.0%。所有结肠直肠癌以远端结肠（直肠、乙状结肠）为主（66.7%）;结肠直肠息肉与结肠直肠癌并存患者数占结肠直肠癌总数的36.6%。症状筛查组的结肠直肠息肉检出率为33.0%,结肠直肠癌检出率为2.5%;无症状筛查组的结肠直肠息肉检出率为41.2%,结肠直肠癌检出率为3.2%。2组间的结肠直肠息肉检出率差异有统计学意义,而结肠直肠癌检出率差异无统计学意义。结论：上海市嘉定地区接受结肠镜检查人群的结肠直肠息肉检出率较高,针对粪便隐血筛查阳性的无症状人群进行结肠镜检查,对于早期发现结肠直肠肿瘤有重要意义。

Objective： To investigate the distribution of colorectal neoplastic disease in subjects with and without symptoms for guiding further study on diagnosis and treatment of colorectal cancer. Methods： A total of 3 509 cases undergoing colonoscopy during Jan. 2013 to Feb. 2014 were enrolled. Data including gender, age, symptoms, changes found during colonoscopy and results of pathology examination were collected. Subjects were divided into 2 groups： symptomatic group（ such as abdominal pain, diarrhea, mucous stool and abdominal distension） and symptom free group（with positive fecal occult blood test）. Results： The average age was（55±13） years, and 2 870 cases had symptoms while 639 cases did not. The detection rates for colorectal polyps and neoplastic disease were 34.4% and 2.6%, respectively. Detection rates were not different between male and female. For subjects aged 60-69 years, 41 patiets（41/459） were diagnosed as colorectal cancer. And 66.7% of the lesions were located at rectum or sigmoid colon, 36.6% of colorectal cancer were ac-companied with colorectal polyps. The positive rate of colorectal polyps was 33.0% in symptomatic group, while was 41.2%in the symptom free group（P〈0.05）. The positive rate of colorectal cancer was 2.5% in symptomatic group, while was 3.2%in symptom free group（P〈0.05）. Conclusions： The detection rate of colorectal polyps in Jiading distract of Shanghai is high. Colonoscopy is an effective screening approach for early detection of colorectal cancer in symptom free subjects with positive fecal occult blood test.