| 杨金华,沈飞琼,薛 峰.2007—2016年浙江省嘉善县结直肠癌筛查方案应用评价[J].中国肿瘤,2020,29(12):919-924. |
| 2007—2016年浙江省嘉善县结直肠癌筛查方案应用评价 |
| Evaluation of Colorectal Cancer Screening Program in Jia-shan County of Zhejiang Province，2007—2016 |
| 中文关键词 修订日期：2020-05-06 |
| DOI：10.11735/j.issn.1004-0242.2020.12.A006 |
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| 中文关键词: 结直肠癌 筛查 问卷调查 粪便潜血试验 浙江 |
| 英文关键词:colorectal cancer screening questionnaire fecal occult blood test Zhejiang |
| 基金项目: |
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| 中文摘要: |
| 摘 要：［目的］ 分析2007—2016年浙江省嘉善县结直肠癌筛查方案结果，为今后结直肠癌筛查方法改进提供依据。 ［方法］ 在2006年完成基线调查的基础上，嘉善县于2007年7月开始正式实施结直肠癌早诊早治项目，至2016年8月完成县域内年龄在40~74岁全部户籍居民的初筛，采用问卷调查+粪便潜血试验（大肠癌优化序贯筛查方案），完成157 170人的初筛，其中问卷调查150 415人，粪便潜血试验133 940人。通过初筛确定高危人群27 752人，最终21 001人完成肠镜检查。 ［结果］ 完成肠镜检查的21 001人中，检出结直肠癌208例，进展期腺瘤970例，非进展期腺瘤3923例，其对结直肠癌、进展期腺瘤、非进展期腺瘤的病变检出率分别为0.99%、4.62%、18.68%。问卷调查对结直肠癌、进展期腺瘤的病变检出率与优化序贯方案无明显差异（P分别为0.720、0.130），对非进展期腺瘤的病变检出率低于优化序贯方案（P＜0.001）。粪便潜血试验对结直肠癌、进展期腺瘤、非进展期腺瘤的病变检出率均高于优化序贯方案和问卷调查（P均＜0.05）。嘉善县各镇（街道）初筛顺应性乡镇（街道）高于城关街道，顺应性较高的镇为较低的1.49倍。城关地区初筛顺应性存在明显差异，农村社区（村）明显高于城镇社区（分别为84.24%、39.24%）。结直肠癌、非进展期腺瘤检出率城镇社区均高于农村社区（村），差异有统计学意义（P分别为0.004、0.006）；进展期腺瘤检出率，城镇社区与农村社区（村）相近，差异无统计学意义（P=0.127）。 ［结论］ 问卷调查+粪便潜血试验（大肠癌优化序贯筛查方案）是我国结直肠癌筛查的基本方法，对结直肠癌高危人群的筛选有一定的作用，但在问卷顺应性及粪便检测灵敏度上仍有改进空间，应在筛查普惠度及粪便检测灵敏度上进一步优化。 |
| 英文摘要: |
| Abstract：［Purpose］ To evaluate the colorectal cancer screening program in Jiashan County from 2007 to 2016. ［Methods］ Based on the survey completed in 2006，the project of early diagnosis and treatment of colorectal cancer was implemented in Jiashan County in July 2007. The initial screening among 157 170 residents aged 40~74 in the county was completed in August 2016，including 150 415 respondents for questionnaire survey and 133 940 respondents for fecal occult blood test. Total 27 752 high-risk subjects were identified，and eventually 21 001 individuals underwent colonoscopy. ［Results］ Among 21 001 individuals receiving colonoscopy，208 cases of colorectal cancer，970 cases of advanced adenoma and 3923 cases of non-advanced adenoma were detected. The detection rates of colorectal cancer，advanced adenoma and non-advanced adenoma were 0.99%，4.62% and 18.68%，respectively. There was no significant difference in the detection rate of colorectal cancer and advanced adenoma between the questionnaire survey and the optimized sequential protocol(P=0.720 and 0.130)，while the detection rate of non-advanced adenoma in questionnaire survey was lower than that in optimized sequential protocol(P<0.001) . The positive rate of stool occult blood test for colorectal cancer，advanced adenoma and non-advanc adenoma was higher than that of optimized sequential protocol and questionnaire(P<0.05) . The compliance of rural township in Jiashan County was 1.49 times higher than that of urban area of the county. The adaptability of primary screening in rural community(village) than that in urban community(84.24% vs 39.24%) . The positive rates of colorectal cancer and non-advanced adenomas in urban community were higher than those in rural community(P=0.004，0.006)，while there was no significant difference in the positive rates of advanced adenomas between urban and rural communities(P=0.127) . ［Conclusion］ The optimized sequential screening program for colorectal cancer(questionnaire survey plus fecal occult blood test) is the basic method for colorectal cancer screening in China，and it has certain effect on screening high risk population of colorectal cancer，but there is still room for improvement in the future. |
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