陈光远 徐立新

摘 要 目的：分析上海市嘉定區工业区2017-2019年大肠癌的筛查结果。方法：采用危险度评估问卷调查结合两次粪便隐血试验（FOBT）初筛模式，初筛阳性提示为大肠癌高危人群，建议肠镜检查。分析2017-2019年上海市嘉定区工业区大肠癌初筛及肠镜检查结果。结果：2017-2019年嘉定工业区在50～74岁人群中共完成初筛6 796人次。农村和城镇片区中均是女性参与人数多于男性，且50～59岁年龄组占比较低。总的初筛阳性率为21.25%，其中农村片区的初筛阳性率低于城镇片区，差异有统计学意义（16.85%比34.955%，P<0.001）。初筛阳性率随年龄的增加而呈上升趋势。农村地区“仅FOBT阳性者”的构成比低于城市地区，“问卷和FOBT阳性者”构成比高于城市地区，差异有统计学意义（P<0.01）。初筛阳性居民中共计623例进行肠镜检查，肠镜检查依从性率为43.14%（623/1444），农村地区肠镜检查依从性率为明显高于城市地区（52.83%比28.60%，P<0.001）。肠镜检查的结果显示，农村地区癌前病变检出率低于城市地区（14.41%比22.42%，P<0.05）。结论：上海嘉定工业区大肠癌筛查结果存在明显的城乡差异。提示在大肠癌筛查过程中，应该采有针对性的筛查措施，以优化筛查模式，使得更多的居民受益于大肠癌筛查项目。

关键词 大肠癌；筛查；社区

中图分类号：R735.3 文献标志码：A 文章编号：1006-1533（2021）24-0055-04

Analysis of the results of colorectal cancer screening in Industrial Zone of Jiading District， Shanghai from 2017 to 2019

CHEN Guangyuan， XU Lixin（Department of Prevention and Health Care of Industrial Zone Community Health Service Center of Jiading District， Shanghai 201821，

China）

ABSTRACT Objective： To analyze the results of colorectal cancer screening in Industrial Zone of Jiading District， Shanghai from 2017 to 2019. Methods： Using the preliminary screening mode of a risk assessment questionnaire survey combined with two times of fecal occult blood test（FOBT）， a positive preliminary screening indicated that the population was at high risk of colorectal cancer， and colonoscopy was recommended. Results： From 2017 to 2019， a total of 6 796 people aged 50～74 completed initial screening in Industrial Zone of Jiading District. In both rural and urban areas， the number of female participants was more than that of male ones， and the age group of 50～59 years old accounted for a relatively low proportion. The total initial screening positive rate was 21.25%， the initial screening positive rate in rural areas was lower than that in urban areas， and the difference was statistically significant（16.85%vs34.955%， P<0.001）. The positive rate of primary screening increased with age. The proportion of “only FOBT positive” in rural areas was lower than that in urban areas， the proportion of “questionnaire and FOBT positive” in rural areas was higher than that in urban areas， and the difference was statistically significant（P<0.01）. A total of 623 residents who were initially screened positive underwent colonoscopy. The compliance rate of enteroscopy was 43.14%（623/1 444）， and the compliance rate of enteroscopy in rural areas was significantly higher than that in urban areas（52.83%vs28.60%， P<0.001）. The results of colonoscopy showed that the detection rate of precancerous lesions in rural areas was lower than that in urban areas（14.41%vs22.42%， P<0.05）. Conclusion： There are significant differences in colorectal cancer screening results between urban and rural areas in Industrial Zone of Jiading District， Shanghai. It is suggested that in the process of colorectal cancer screening， targeted screening measures should be adopted to optimize the screening mode， so that more residents can benefit from the colorectal cancer screening program.

KEY WORDS colorectal cancer； screening； community

大肠癌是我国常见的恶性肿瘤之一。2018年国家癌症中心发布的最新数据显示，大肠癌位居我国癌症发病率第4位，每年新发癌症病例达429万，占全球新发病例的1/4；死亡281万例，死亡率排在第2位，且近年来发病增速十分显著[1-2]。根据上海市嘉定区肿瘤登记资料显示，嘉定区2012-2017年大肠癌的累积发病率位于第2位，大肠癌成为威胁嘉定居民健康的主要恶性肿瘤。……