上海市某社区居民大肠癌筛查的优化效果分析

Optimization of colorectal cancer screening in a community of Shanghai

为分析上海市浦江镇社区居民大肠癌筛查的优化效果，比较2015和2016年度接受大肠癌筛查居民的大便隐血阳性率、接受肠镜检查的顺应率、肠癌和息肉的检出率等方面的差异。2015年度，粪便检查粪隐血（FOBT）阳性者4564例，占纳入筛查总人数的20．00％（4564／22819）。707例接受进一步肠镜筛查，顺应率15．49％（707／4564），大肠息肉性病变240例（其中大肠腺瘤167例），大肠上皮内瘤变30例，大肠炎性病变6例，肠镜检出大肠癌4例，其他3例，无异常者424例。2016年度，粪便检查FOBT阳性者2947例，占纳入筛查总人数的12．58％（2947／23424），817例接受进一步肠镜筛查，顺应率27．72％（817／2947）。大肠息肉性病变430例（其中大肠腺瘤330例），大肠上皮内瘤变101例，大肠炎性病变9例，肠镜检出大肠癌5例，其他5例，无异常者267例。两年度筛查结果比较，接受肠镜检查的顺应率差异有统计学意义（P〈0．05）；肠癌、炎症及其他病变检出率差异无统计学意义（均P〉0．05）；上皮内瘤变、息肉（腺瘤）检出率差异有统计学意义（均P〈0．05）。开展优化措施可以提高结肠癌社区筛查中FOBT阳性者接受肠镜检查的顺应性，提高大肠癌及癌前病变的早发现率。

The colorectal cancer screening program was implemented in Pujiang community health service center of Minhang District of Shanghai in 2015 （ before optimization） and 2016 （ after optimization ）. The screening results were compared between 2015 and 2016. In 2015 the positive rate of FOBT was 20% （4 564/22 819） , and 707 subjects received further screening eolonoseopy with a compliance rate of 15.49% （707/4 564）. Colonoscopy detected 4 cases of eolorectal cancer,30 cases of intraepithelial neoplasia,240 cases of coloreetal polyps （ including 167 cases of coloreetal adenoma） and 6 cases of colorectal inflammatory lesions. In 2016 the positive rate of FOBT was 12.58% （2 947/23 424） , 817 subjects received screening colonoseopy with a compliance rate of 27.72% （817/2 947）. Colonoscopy detected 5 cases of coloreetal cancer, 101 cases of intraepithelial neoplasia, 430 cases of polyps （including 330 cases of colorectal adenoma） and 9 cases of inflammation lesions. There were no significant differences in the detection rates of colorectal cancer, inflammatory and other lesions between 2015 and 2016 （ P 〉 0.05 ） , the colonoscopy compliance, detection rate of intraepithelial neoplasia and polyps in 2016 were significantly higher than those in 2015 （P 〈 0.05 ）. The results suggest that through various measures to optimize the implementation of the eolorectal cancer screening, community health service center can improve the colonoscopy compliance in FOBT-positive subjects,the early detection rate of precancerous lesions and polyps in the community.