上海市闵行区颛桥镇社区居民结直肠癌筛查结果和结肠镜依从性探讨

Results of Colorectal Cancer Screening and Colonoscopic Compliance Among Community Residents in Zhuanqiao Town,Minhang District,Shanghai

背景:结直肠癌是临床常见恶性肿瘤之一,近年我国发病率和死亡率均呈上升趋势。目的:分析上海市闵行区颛桥镇社区居民的结直肠癌筛查结果和影响结肠镜检查依从性的因素。方法:以2020年7月-2021年1月期间在颛桥镇参加结直肠癌筛查的社区居民为研究对象,采用危险度评估问卷调查与粪便隐血试验(FOBT)相结合的方法进行初筛,初筛阳性者建议行结肠镜检查,并对不愿行结肠镜检查者进行原因调查。结果:研究期间共6383例居民参与筛查,危险度评估、FOBT和总体初筛阳性率分别为7.2%(459例)、10.5%(670例)和17.2%(1095例)。初筛阳性者中297例接受结肠镜检查,应答率为27.1%,60~69岁年龄段依从性最高(P<0.05)。结直肠癌检出率为2.0%(6/297)。对结直肠癌认识不足、无明显身体不适是影响高危人群结肠镜依从性的主要原因。结论:危险度评估结合FOBT能快速、高效地识别出结直肠癌高危人群。对于社区居民结直肠癌筛查项目,应加强宣教力度,提高居民认知水平,并不断完善筛查程序。

Background: Colorectal cancer(CRC) is one of the most common malignancies in clinical practice. Its incidence and mortality rate are increasing in China in recent years. Aims: To analyze the results of CRC screening and the factors affecting the compliance of colonoscopy among community residents in Zhuanqiao Town, Minhang District, Shanghai. Methods: The community residents who were screened for CRC in Zhuanqiao Town from July 2020 to January 2021 were recruited. Both the risk assessment questionnaire and the fecal occult blood test(FOBT) were performed for the primary screening, and those who were positive for primary screening were recommended to undergo colonoscopy. High-risk individuals unwilling to undergo colonoscopy were surveyed for the reason of refusal. Results: During the study period, a total of 6 383 residents participated in the screening program, the positivity rates of risk assessment, FOBT and with either of them were 7.2%(459 cases), 10.5%(670 cases) and 17.2%(1 095 cases), respectively. Two hundred and ninety-seven residents who were positive for primary screening underwent a colonoscopy, with an overall colonoscopic compliance rate of 27.1%. The colonoscopic compliance rate in residents aged from 60-69 years was higher than that in other age groups(P<0.05). The detection rate of CRC was 2.0%(6/297). Insufficient knowledge of CRC and having no obvious physical discomfort were the main factors affecting colonoscopic compliance in high-risk population. Conclusions: Risk assessment combined with FOBT can identify high-risk population of CRC rapidly and efficiently. For the CRC screening program, education of the knowledge on CRC should be strengthened for improving the cognitive level of CRC in community residents. The screening program should be further optimized.