刘玲 朱立场

摘 要 目的：分析社区结直肠癌（CRC）的筛查结果，为CRC的早发现、早诊断、早治疗提供依据。方法：用粪便隐血试验（FOBT）联合危险度评估进行CRC初步筛查，对初筛阳性者鼓励进行全结直肠镜检查，分析筛查结果。结果：2013年5月至2013年12月上海塘桥社区共4 992位50岁以上居民接受筛查，初筛阳性1 061例，初筛阳性率21.3%。初筛阳性对象中有355人接受全结肠镜检，肠镜应答率为33.5%。全结直肠镜检出有结直肠病变91例，其中包括76例结直肠息肉、1例腺瘤及14例CRC，CRC检出率280.4/10万（14/4992）。结论：以危险度评估及FOBT作为初筛的两步筛查模式可以有效地检出大肠的病变。上海塘桥社区居民结直肠癌发生率较高，社区卫生服务人员需要依据筛查结果对居民进行健康宣教，提高居民的健康意识，促使居民养成良好的生活习惯。

关键词 结直肠癌；筛查；危险度评估；粪便隐血试验；结肠镜

中图分类号：R735.3+4 文献标志码：A 文章编号：1006-1533（2019）04-0042-04

Preliminary analysis of screening results of colorectal cancer in a community in Shanghai

LIU Ling1， ZHU Lichang2（1. General Practice Department of Tangqiao Community Health Service Center of Pudong New District， Shanghai 200127， China； 2. General Practice Department of Shanggang Community Health Service Center of Pudong New District， Shanghai 200126， China）

ABSTRACT Objective： To analyze the screening results of colorectal cancer（CRC） in the community for providing evidence for early detection， diagnosis and treatment of CRC. Methods： CRC was preliminarily screened by fecal occult blood test（FOBT） combined with risk assessment， for those with positive initial screening， total colorectal endoscopy was encouraged and the results of screening were analyzed. Results： From May to December 2013， 4 992 residents over 50 years old in the Tangqiao Community of Shanghai accepted the screening， 1 061 cases were positive for primary screening， and the positive rate of initial screening was 21.3%. Three hundred and fifty-five people in the primary screening subjects underwent total colonoscopy， and the colonoscopy response rate was 33.5%. 91 cases of colorectal lesions were detected by total colorectal endoscopy， including 76 cases of colorectal polyps， 1 case of adenoma and 14 cases of CRC， and the CRC detection rate was 280.4/100 000（14/4 992）. Conclusion： The two-step screening mode of risk assessment and FOBT screening can effectively detect lesions in the large intestine. The incidence of colorectal cancer in residents of Tangqiao Community in Shanghai is high， and community health service staffs need to conduct health education to residents according to the results of screening， improve residents health awareness， and encourage residents to develop good living habits.

KEY WORDS colorectal cancer； screening； risk assessment； fecal occult blood test； colonoscopy

結直肠癌（colorectal cance，CRC）是世界上排列第三位的癌症[1-2]，也是癌症死亡中排列第四位的原因[1]。我国CRC发病率和死亡率均呈现逐渐上升的趋势[3-4]，尤其在上海等发达城市，CRC的发病率和死亡率急剧上升，几乎达到了发达国家的发病率水平；我国大肠癌诊断为I期的比例仅占5%，超过60%的大肠癌患者确诊时已经处于中晚期[5]。CRC患者发病早期无明显的临床症状，当出现相关症状时多数患者病情已经进入了晚期，治疗效果不是十分理想，严重影响了患者的生存质量。但是，CRC患者往往具有明确的癌前病变，非常适宜进行早期诊断和早期治疗。……