张烜昭+陈凌+刘萍+顾昊

摘 要 目的：探索在社区信息化平台上开展社区常见肿瘤早发现工作模式，提高社区肿瘤早发现水平。方法：应用电子健康档案的信息化平台，通过门诊因症就诊、社区健康教育、健康体检三个途径在莘庄镇40岁以上的签约居民中共完成胃癌、结直肠癌、肝癌和肺癌的筛查健康问卷94 792份，并建立高危队列进行随访管理。结果：从筛查健康问卷中筛查出51 325人纳入初筛库，其中50 605人完成规范初筛检出，规范初筛率为98.60%；确诊胃癌、结直肠癌、肝癌和肺癌共110例，其中54例为癌症早期，癌症早发现率为49.09%；结直肠癌的早发现率为80.56%（29/36），检出癌症高危对象1 411例。结论：以社区为基础，利用居民电子健康档案信息化平台开展肿瘤早发现工作，能有效的提高社区肿瘤早发现水平，提高治愈率和生存率。

关键词 恶性肿瘤；早发现；筛查；社区

中图分类号：R194.3 文献标志码：A 文章编号：1006-1533（2017）10-0046-03

Research on screening mode of early detection of the common malignant tumor based on community information platform

ZHANG Xuanzhao， CHEN Ling， LIU Ping， GU Hao

（Xinzhuang Community Health Service Center of Minhang District， Shanghai 201199， China）

ABSTRACT Objective： To explore the working mode of early detection of the common malignant tumor in the community on the community information platform. Methods： With application of electronic health records information platform， a total of 94 792 residents over the age of 40 in Xinzhuang Community completed a screening questionnaire for gastric cancer， colorectal cancer， liver cancer and lung cancer through three ways of outpatient clinic， community health education and health examination， and the established high-risk cohort was followed up and managed. Results： A total of 51 325 people screened from the screening questionnaire were brought into the primary screening library， among them， 50 605 people completed the preliminary screening of the specification， and the standard screening rate was 98.60%. A total of 110 cases were diagnosed to have gastric cancer， colorectal cancer， liver cancer and lung cancer， among them， 54 cases were early cancers， and the early detection rate was 49.09%. The early detection rate of colorectal cancer was 80.56% （29/36）， and 1 411 cases of cancer risk objects were detected. Conclusion： Based on the community， application of electronic health records information platform to carry out early detection of cancer can effectively improve the level of early detection of the tumor and improve the cure and survival rates.

KEY WORDS cancer； early detection； screening； community

随着社会经济的发展，慢性非传染性疾病已成为我国主要的公共卫生问题[1]，而恶性肿瘤问题尤其突出，我国恶性肿瘤诊治每年花费数百亿元，仍然每死亡5人即有1人死于癌症，而在64歲以下的人群中每死亡4人中即有1人死于癌症[2]。早预防、早发现、早诊断、早治疗是治愈肿瘤，提高生存率的关键[3]。故莘庄社区卫生服务中心2008年建立了以居民电子健康档案（electronic health records，EHR）为基础的社区肿瘤早发现平台，本文旨在探索基于EHR信息化平台开展常见恶性肿瘤筛查模式。

1 对象与方法

1.1 筛查对象

选取莘庄镇40及以上户籍居民为研究对象，在EHR信息化平台上通过门诊因症就诊、社区健康教育、健康体检三种途径开展肿瘤筛查健康问卷调查和早期筛查工作，并建立高危队列进行随访和追踪。……