结直肠癌筛查发现的7 408例肠道病变临床特征及病理类型分析

Clinical features and pathology of 7 408 colorectal lessions based on colorectal cancer screening

摘要:

目的 探讨结直肠病变患者临床与病理特征，为结直肠癌早期临床诊断与干预提供依据。 方法 基于2007至2012年海宁市32万余40～74岁目标人群结直肠癌筛查结果，对筛查检出的肠道病变进行临床特征（包括性别、年龄、大小、部位、形态、数目）及病理类型等分析探讨。 结果 共完成初筛286 470例，顺应率88.96％；完成结肠镜检查29 069例，检出肠道病变7 408例，检出率25.48％；男性检出率高于女性（32.62%比19.48%，P＜0.001）；40～49岁组检出率18.30％，70～74岁组检出率35.06％，显示年龄越大检出率越高（P＜0.001）。7 408例肠道病变中，左半结肠约占69.40%，多发性病变占37.23％，＞1.0 cm病变占19.60％。检出结直肠癌205例（早期癌161例、中晚期癌44例），进展期腺瘤1 365例，早诊率为97.20％。手术切除的5 030例病变病理提示腺瘤型及以上病变所占比重最大（63.00％）。直径＞1.5 cm病变癌变率为34.08%。 结论 在高危人群中男性肠道病变检出率明显高于女性，年龄越大检出率越高；病理类型以腺瘤所占比重最高。

Abstract:

Objective To investigate the clinical and pathological features of patients with colorectal lesions， which could be the basis for clinical diagnosis and treatment of early colorectal cancer. Methods The clinical （including gender， age， size， location， morphology， and number） and pathological characteristics of colorectal lesions were discussed based on the results of colorectal cancer screening in more than 320 000 people of 40-74 years in Haining from 2007 to 2012. Results Screening of 286 470 cases were completed with the compliance rate of 88.96％. Colonoscopy was performed in 29 069 cases， and 7 408 lesions were detected with detection rate of 25.48％. The detection rate was 32.62％ for men and 19.48％ for women （P＜0.001）， and 18.30％ in 40-49 age group and 35.06％ in 70-74 age group. The older the patients， the higher the detection rate （P＜0.001）. Among the 7 408 lesions， left colonic lesions accounted for 69.40％， multiple lesions accounted for 37.23％， lesions with diameter ＞1.0 cm accounted for 19.60％. A total of 205 cases of colorectal cancer （including 161 early carcinoma and 44 advanced carcinoma）， and 1 365 cases of advanced adenoma were found. The early diagnosis rate was 97.20％. Among the 5 030 lesions underwent treatment， adenomatous and carcinomatous types accounted for the largest proportion （63.00％）. The canceration rate of lesions with diameter ＞1.5 cm was 34.08％. Conclusion In high-risk populations， men have a higher detection rate of colorectal lesion than female. The older the age， the higher the detection rate. Adenoma account for the highest proportion among different pathologic types.